Delirium in Children After Cardiac Bypass Surgery*

Abstract

Background Delirium is acute brain dysfunction associated with serious illness. Emerging data indicate that delirium occurs in greater than 20% of children in pediatric intensive care units. Cardiac bypass surgery is a known risk factor for delirium in adults, but has never been systematically studied in pediatrics. Objectives To describe the incidence of delirium in pediatric patients after cardiac bypass surgery, and explore associated risk factors and effect of delirium on in-hospital outcomes. Design Prospective observational single-center study. Setting Fourteen-bed pediatric cardiothoracic intensive care unit (PCICU). Patients One hundred and ninety four consecutive admissions following cardiac bypass surgery, age one day to 21 years. Interventions Subjects were screened for delirium daily using the Cornell Assessment of Pediatric Delirium. Measurements and Main Results Incidence of delirium in this sample was 49%. Delirium most often lasted 1–2 days, and developed within the first 1–3 days after surgery. Age less than two years, developmental delay, higher RACHS-1 score, cyanotic disease, and albumin less than three were all independently associated with development of delirium in a multivariable model (all p values <0.03). Delirium was an independent predictor of prolonged ICU LOS, with patients who were ever delirious having a 60% increase in ICU days compared to patients who were never delirious (p<0.01). Conclusions In our institution, delirium is a frequent problem in children after cardiac bypass surgery, with identifiable risk factors. Our study suggests that cardiac bypass surgery significantly increases children’s susceptibility to delirium. This highlights the need for heightened, targeted delirium screening in all PCICUs to potentially improve outcomes in this vulnerable patient population.

Psychotropic medication use trends in a large pediatric and young adult solid organ transplant population

“…We suspect delirium would have had a significant association and high odds of psychotropic usage in thoracic organ population given the prolonged periods of time in the ICU and frequency of events that impact acute neurocognitive functioning (eg, hypotension, sepsis, hypercapnia, hypoxemia, and mechanical ventilation). 19,20 Finally, significant thoracic organ Nevertheless, there is evidence to support the combination of therapy and medication for effective treatment of anxiety in pediatric patients, 24 and 50% of SOT patients with anxiety in our sample had a lifetime psychotropic medication history. Depression, mood, and anxiety disorders are significant predictors of morbidity, mortality, and adherence in medically ill patients [25][26][27] and should be adequately treated in SOT patients in order to improve outcomes.…”

“…As standardized delirium assessment was not conducted for these patients, the association with delirium, unfortunately, could not be further evaluated in detail. We suspect delirium would have had a significant association and high odds of psychotropic usage in thoracic organ population given the prolonged periods of time in the ICU and frequency of events that impact acute neurocognitive functioning (eg, hypotension, sepsis, hypercapnia, hypoxemia, and mechanical ventilation) . Finally, significant thoracic organ psychotropic medication use may also be attributed to the higher frequency of medical decompensation while awaiting transplant and immediately post‐transplant compared to abdominal organ disease, as end‐of‐life disease progression was also a significant variable for psychotropic usage in our study.…”

The Cornell Assessment of Pediatric Delirium: Translation and inter‐rater reliability in a Danish pediatric intensive care unit

“…Evaluation and treatment of delirium in critically ill children has garnered attention in the world of pediatrics . There are only a few international studies on PD and these studies suggest a prevalence rating from 25% to 66% . PD is associated with high morbidity and mortality and prolonged lengths of stay in intensive care .…”

Pediatric Delirium in the Cardiac Intensive Care Unit: Identification and Intervention

“…In the pediatric cardiac ICU (PCICU), delirium rates of up to 49% have been reported. 5 In order to identify and treat pediatric patients afflicted with ICU delirium, it is important to be familiar with the definition of delirium, its risk factors, available screening tools, and possible interventions.…”