Background Communication with family members of Intensive Care Unit (ICU) patients is challenging and fraught with dissatisfaction. Objectives We hypothesized that family attendance at structured interdisciplinary Family Rounds would enhance communication and facilitate end-of-life planning (when appropriate). Methods The study was conducted at the 26-bed medical ICU of a tertiary care, academic, medical center from April through October 2006. Implementation of Family Rounds occurred in July 2006, after which families were invited to attend daily interdisciplinary rounds while the medical team discussed the plan for care. Family members were surveyed at least one month following the ICU stay using the validated “Family Satisfaction in ICU (FS-ICU)” tool prior to and after implementation of Family Rounds. Results Of 227 patients enrolled, 187 patients survived and 40 died. Among families of survivors, participation in Family Rounds was associated with higher family satisfaction regarding frequency of communication with physicians (p=0.004) and support during decision making (p=0.005). Participation decreased satisfaction regarding time for decision making (p=0.02). There was no difference in overall satisfaction scores. For families of patients who died, participation in Family Rounds did not significantly change satisfaction. Conclusions In the context of this pilot Family Rounds study, certain elements of satisfaction were improved but not overall satisfaction. The findings pointed out that structured interdisciplinary Family Rounds can be viewed as an improvement in some families’ opinions while others feel rushed to make decisions. More work is needed to optimize communication between ICU personnel and patients’ families, their comprehension, and the affects on ICU team workload.

Objectives: Delirium is prevalent among critically ill children, yet associated outcomes and modifiable risk factors are not well defined. The objective of this study was to determine associations between pediatric delirium and modifiable risk factors such as benzodiazepine exposure and short-term outcomes. Design: Secondary analysis of collected data from the prospective validation study of the Preschool Confusion Assessment Method for the ICU. Setting: Tertiary-level PICU. Patients: Critically ill patients 6 months to 5 years old. Interventions: None. Measurements and Main Results: Daily delirium assessments were completed using the Preschool Confusion Assessment Method for the ICU. Associations between baseline and in-hospital risk factors were analyzed for likelihood of ICU discharge using Cox proportional hazards regression and delirium duration using negative binomial regression. Multinomial logistic regression was used to determine associations between daily risk factors and delirium presence the following day. Our 300-patient cohort had a median (interquartile range) age of 20 months (11–37 mo), and 44% had delirium for at least 1 day (1–2 d). Delirium was significantly associated with a decreased likelihood of ICU discharge in preschool-aged children (age-specific hazard ratios at 60, 36, and 12 mo old were 0.17 [95% CI, 0.05–0.61], 0.50 [0.32–0.80], and 0.98 [0.68–1.41], respectively). Greater benzodiazepine exposure (75–25th percentile) was significantly associated with a lower likelihood of ICU discharge (hazard ratio, 0.65 [0.42–1.00]; p = 0.01), longer delirium duration (incidence rate ratio, 2.47 [1.36–4.49]; p = 0.005), and increased risk for delirium the following day (odds ratio, 2.83 [1.27–6.59]; p = 0.02). Conclusions: Delirium is associated with a lower likelihood of ICU discharge in preschool-aged children. Benzodiazepine exposure is associated with the development and longer duration of delirium, and lower likelihood of ICU discharge. These findings advocate for future studies targeting modifiable risk factors, such as reduction in benzodiazepine exposure, to mitigate iatrogenic harm in pediatric patients.

RATIONALE and OBJECTIVE Delirium assessments in critically ill infants and young children pose unique challenges due to evolution of cognitive and language skills. The objectives of this study were to determine the validity and reliability of a fundamentally objective and developmentally appropriate delirium assessment tool for critically ill infants and preschool-aged children, and to determine delirium prevalence. DESIGN and SETTING Prospective, observational cohort validation study of the PreSchool Confusion Assessment Method for the ICU (psCAM-ICU) in a tertiary medical center pediatric ICU. PATIENTS Participants aged 6 months to 5 years and admitted to the pediatric ICU regardless of admission diagnosis were enrolled. INTERVENTIONS, MEASUREMENTS and MAIN RESULTS An interdisciplinary team created the psCAM-ICU for pediatric delirium monitoring. To assess validity, patients were independently assessed for delirium daily by the research team using the psCAM-ICU and by a child psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders criteria. Reliability was assessed using blinded, concurrent psCAM-ICU evaluations by research staff. A total of 530-paired delirium assessments were completed among 300 patients, with a median age of 20 months (IQR 11, 37) and 43% requiring mechanical ventilation. The psCAM-ICU demonstrated a specificity of 91% (95%CI 90, 93), sensitivity of 75% (72, 78), negative predictive value of 86% (84, 88), positive predictive value of 84% (81, 87), and a reliability kappa statistic of 0.79 (0.76, 0.83). Delirium prevalence was 44% using the psCAM-ICU and 47% by the reference-rater. The rates of delirium were 53% vs. 56% in patients < 2 years of age and 33% vs. 35% in patients ≥ 2 - 5 years of age using the psCAM-ICU and reference-rater respectively. The short-form psCAM-ICU maintained a high specificity (87%) and sensitivity (78%) in post-hoc analysis. CONCLUSIONS The psCAM-ICU is a highly valid and reliable delirium instrument for critically ill infants and preschool-aged children, in whom delirium is extremely prevalent.