Objective Intensive care unit (ICU) delirium has been associated with increased length of hospital stay, morbidity, mechanical ventilation, and health care resource utilization. Antipsychotics are frequently used for ICU delirium management, despite a lack of robust evidence in the literature to support their benefit. Delirium screening may result in pharmacologic or non-pharmacologic treatment. Methods In January 2019 we began screening patients admitted to the pediatric ICU (PICU) for delirium using the Cornell Assessment for Pediatric Delirium (CAPD). We compared prescribing rates of antipsychotic medications before and after implementation. We also assessed length of hospital and ICU stay prior to initiating therapy, delirium score prior to initiation of therapy, time after initiation of therapy until score decreased to a level not suggestive of delirium, and continuation of antipsychotics outside of the PICU. Results We did not observe a difference in the rate of antipsychotics use. There was, however, an increase in variability between pre- and post-intervention rates of prescribing. Patients who received an antipsychotic medication were hospitalized for an average of 18 days and in the ICU for 14 days prior to the first dose of an antipsychotic agent. They had an average CAPD score of 16, and had an average of 4 scores above 8 prior to starting treatment. Conclusion This study highlights the need for additional research to demonstrate the role of antipsychotic medications in managing delirium in the PICU.
Pediatric delirium is an often underrecognized and reversible complication of illness; it is a clinical emergency demanding immediate management. Pediatric delirium requires prompt identification, medical investigation, and treatment of the symptoms and the underlying cause, when possible. Alterations in brain function co-occur with complex medical illness in compromised patients leading to significant negative outcomes. These include higher morbidity and mortality, lengthened hospital stay, and negative psychological sequelae for patients and their families, as well as for clinical caregivers. This chapter highlights the importance of screening, early assessment, treatment, education, and psychological support for patients, families, and clinicians from all disciplines.
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