Delirium in hospitalised children

Dechnik, Andzelika; Traube, Chani

doi:10.1016/s2352-4642(19)30377-3

Cited by 42 publications

(25 citation statements)

References 80 publications

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“…A large body of delirium literature demonstrates a strong and consistent relationship between benzodiazepines and pediatric delirium (1,3,5,10,22,24,32). In fact, a recent systematic review and meta-analysis described a pooled odds ratio of 3.5 for benzodiazepines and delirium in children (9). In contrast to the existing delirium literature, we did not find a significant relationship between benzodiazepine exposure and delirium in our cohort.…”

Section: Prescribing Practicescontrasting

confidence: 98%

“…This is in contrast to a randomized placebo-controlled trial in a geriatric population that suggested that nightly ramelteon (a melatonin agonist) may provide protection against delirium (31). It is physiologically plausible that in our pediatric cohort, melatonin predisposed to hypoactive delirium, or it may be that melatonin was prescribed to promote sleep in children who were already experiencing delirium, as delirium in young children is known to cause significant circadian rhythm disruption (9). One cannot disentangle this chicken-and-egg phenomenon with the current study design.…”

Section: Iatrogenic Risk Factors For Deliriummentioning

confidence: 68%

“…Studies have shown that children diagnosed with delirium have increased short-and long-term morbidity, and even excess mortality (5)(6)(7). Modifiable iatrogenic risk factors have been identified for delirium in critically ill children, and changes in treatment approaches have led to lower delirium rates in the PICU (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study

et al. 2021

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Introduction: Delirium occurs frequently in adults undergoing hematopoietic cell transplantation, with significant associated morbidity. Little is known about the burden of delirium in children in the peri-transplant period. This study was designed to determine delirium rates, define risk factors (demographic and treatment related), and establish feasibility of multi-institutional bedside screening for delirium in children undergoing hematopoietic cell transplant.Methods: This is a multi-institutional point prevalence study. All subjects were prospectively screened for delirium twice daily using the Cornell Assessment of Pediatric Delirium over a 10-day period. De-identified data, including basic demographics and daily characteristics, were extracted from the electronic medical record.Results: Eleven North American institutions were included, 106 children were enrolled, and 883 hospital days were captured. Delirium screening was successfully completed on more than 98% of the study days. Forty-eight children (45%) developed delirium over the course of the 10-day study. Children were diagnosed with delirium on 161/883 study days, for an overall delirium rate of 18% per day. Higher delirium rates were noted in children <5 years old (aOR 0.41 for children over 5 years), and in association with specific medications (melatonin, steroids, and tacrolimus).Conclusion: Delirium was a frequent occurrence in our study cohort, with identifiable risk factors. Delirium screening is highly feasible in the pediatric hematopoietic cell transplant patient population. A large-scale prospective longitudinal study following children throughout their transplant course is urgently needed to fully describe the epidemiology of pediatric delirium, explore the effects of delirium on patient outcomes, and establish guidelines to prevent and treat delirium in the peri-transplant period.

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Section: Prescribing Practicescontrasting

confidence: 98%

Section: Iatrogenic Risk Factors For Deliriummentioning

confidence: 68%

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Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study

et al. 2021

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“…Consequently, raters could not properly assess hypoactive and mixed delirium. To correctly assess pediatric delirium, the Cornell Assessment Pediatric Delirium or the PreSchool Confusion Assessment Method for the ICU should have been used [3].…”

Section: To the Editormentioning

confidence: 99%

Underestimating hypoactive delirium?

2020

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“…Recent studies have demonstrated a consistent and robust association between exposure to benzodiazepines and delirium development in pediatric critical illness [ 1 , 2 , 3 , 4 , 5 ]. As pediatric delirium is related to poor outcomes (including increased duration of mechanical ventilation, increased ICU and hospital length of stay, and even excess mortality), there is a compelling need to explore alternatives to benzodiazepine-based sedation in mechanically ventilated children [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“Difficult to Sedate”: Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children

et al. 2021

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We sought to evaluate the success rate of a benzodiazepine-sparing analgosedation protocol (ASP) in mechanically ventilated children and determine the effect of compliance with ASP on in-hospital outcome measures. In this single center study from a quaternary pediatric intensive care unit, our objective was to evaluate the ASP protocol, which included opiate and dexmedetomidine infusions and was used as first-line sedation for all intubated patients. In this study we included 424 patients. Sixty-nine percent (n = 293) were successfully sedated with the ASP. Thirty-one percent (n = 131) deviated from the ASP and received benzodiazepine infusions. Children sedated with the ASP had decrease in opiate withdrawal (OR 0.16, 0.08–0.32), decreased duration of mechanical ventilation (adjusted mean duration 1.81 vs. 3.39 days, p = 0.018), and decreased PICU length of stay (adjusted mean 3.15 vs. 4.7 days, p = 0.011), when compared to the cohort of children who received continuous benzodiazepine infusions. Using ASP, we report that 69% of mechanically ventilated children were successfully managed with no requirement for continuous benzodiazepine infusions. The 69% who were successfully managed with ASP included infants, severely ill patients, and children with chromosomal disorders and developmental disabilities. Use of ASP was associated with decreased need for methadone use, decreased duration of mechanical ventilation, and decreased ICU and hospital length of stay.

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Delirium in hospitalised children

Cited by 42 publications

References 80 publications

Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study

Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study

Underestimating hypoactive delirium?

“Difficult to Sedate”: Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children

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