Objective To determine prevalence of delirium in critically-ill children and explore associated risk factors. Design Multi-institutional point-prevalence study. Setting Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia. Patients All children admitted to the pediatric critical care units on designated study days (n=994). Intervention Children were screened for delirium using the Cornell Assessment of Pediatric Delirium (CAPD) by the bedside nurse. Demographic and treatment-related variables were collected. Measurements and Main Results Primary study outcome measure was prevalence of delirium. In 159 children, a final determination of mental status could not be ascertained. Of the 835 remaining subjects, 25% screened positive for delirium, 13% were classified as comatose, and 62% were delirium-free and coma-free. Delirium prevalence rates varied significantly with reason for ICU admission, with highest delirium rates found in children admitted with an infectious or inflammatory disorder. For children who were in the PICU for 6 or more days, delirium prevalence rate was 38%. In a multivariate model, risk factors independently associated with development of delirium included age < 2 years, mechanical ventilation, benzodiazepines, narcotics, use of physical restraints, and exposure to vasopressors and anti-epileptics. Conclusions Delirium is a prevalent complication of critical illness in children, with identifiable risk factors. Further multi-institutional, longitudinal studies are required to investigate effect of delirium on long-term outcomes, and possible preventive and treatment measures. Universal delirium screening is practical and can be implemented in pediatric critical care units.

Objective To determine the effect of therapeutic plasma exchange (TPE) on hemodynamics, organ failure, and survival in children with multiple organ dysfunction syndrome (MODS) due to sepsis requiring extracorporeal life support (ECLS). Design A retrospective analysis. Setting A pediatric intensive care unit (PICU) in an academic children’s hospital. Patients 14 consecutive children with sepsis and MODS who received TPE while on ECLS from 2005 to 2013. Interventions Median of 3 cycles of TPE with median of 1.0 times the estimated plasma volume per exchange. Measurements and Main Results Organ Failure Index (OFI) and Vasoactive-Inotropic Score (VIS) were measured before and after TPE use. PICU survival in our cohort was 71.4%. OFI decreased in patients following TPE [pre: 4.1 ± 0.7 vs. post: 2.9 ± 0.9 (mean ±SD); p = 0.0004]. Patients showed improved VIS following TPE [pre: 24.5 (13.0–69.8) vs. post: 5.0 (1.5–7.0), median (25th–75th); p = 0.0002]. Among all patients, the change in OFI was greater for early TPE use than late use [pre: −1.7 ±1.2 vs. post: −0.9 ±0.6; p = 0.14], similar to the change in VIS [pre: −67.5 (28.0–171.2) vs. post: −12.0 (7.2–18.5); p = 0.02]. Among survivors, the change in OFI was greater among early TPE use than late use [early: −2.3 ±1.0 vs. late: −0.8 ± 0.8; p = 0.03], as was the change in VIS [early: −42.0 (16.0–76.3) vs. late: −12.0 (5.3–29.0); p=0.17]. The mean duration of ECLS after TPE according to timing of TPE was not statistically different among all patients or among survivors. Conclusions The use of TPE in children on ECLS with sepsis-induced MODS is associated with organ failure recovery and improved hemodynamic status. Initiating TPE early in the hospital course was associated with greater improvement in organ dysfunction and decreased requirement for vasoactive and/or inotropic agents.

Substantial noise pollution exists in our PICU, and utilizing the pediatric delirium bundle led to a significant noise reduction that can be perceived as half the loudness with hourly nighttime average dB meeting the EPA standards when compliant with the bundle.

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