Assessment of delirium in children admitted into the Intensive Care Unit: psCAM-ICU Tool

Abstract

Background: Delirium has been identified as a risk factor for the mortality of critically ill patients, generating great social and economic impacts, since patients require more days of mechanical ventilation and a prolonged hospital stay in the intensive care unit (ICU), thus increasing medical costs. Objective: To describe the prevalence and characteristics of delirium episodes in a sample of 6-month to 5-year-old children who are critically ill. Methods: Cohort study at a Pediatric Intensive Care Unit (PICU) in Bogotá (Colombia). Participants were assessed by the Preschool Confusion Assessment Method for the ICU (psCAM-ICU) within the first twenty-four hours of hospitalization. Results: One quarter of the participants (25.8%) presented some type of delirium. Among them, two sub-types of delirium were observed: 62.5% of the cases were hypoactive and 37.5% hyperactive. Moreover, from them, six were male (75%) and 2 female (25%). Primary diagnosis was respiratory tract infection in 62.55% of the patients, while respiratory failure was diagnosed in the remaining 37.5%. Conclusions: The implementation of delirium monitoring tools in critically ill children provides a better understanding of the clinical manifestation of this phenomenon and associated risk factors in order to contribute to the design of efficient intervention strategies.

A Systematic Review and Pooled Prevalence of Delirium in Critically Ill Children*

“…Twenty-seven (16, 18–22, 35, 38–43, 45–59) were prospective in design, two retrospective (36, 37), and two point prevalence (44, 58). Twenty-seven were single-center studies (16, 18–21, 36–43, 45–57, 59), and four were multicenter studies (22, 35, 44, 58), including two multisite point prevalence studies (44, 58). Twenty-seven took place in a PICU (16, 18–22, 35–43, 45–49, 52–54, 56–59), two in a PCICU (51, 55), one in a mixed PICU and PCICU (50), and one across multiple PCICUs or PICUs (44).…”

“…Twenty-seven were single-center studies (16, 18–21, 36–43, 45–57, 59), and four were multicenter studies (22, 35, 44, 58), including two multisite point prevalence studies (44, 58). Twenty-seven took place in a PICU (16, 18–22, 35–43, 45–49, 52–54, 56–59), two in a PCICU (51, 55), one in a mixed PICU and PCICU (50), and one across multiple PCICUs or PICUs (44). No stand-alone NICU studies were found, but 18 included neonates (18, 36–38, 40–46, 50, 51, 53–56, 58).…”

“…The 31 studies reported on 9,756 children. Twenty studies reported prevalence of PD using CAPD (18, 36–38, 40, 41, 43–46, 48, 50, 51, 53–59) or translated versions (40, 45, 46, 48, 53, 54), eight using variations of the pCAM-ICU (16, 19, 20, 35, 39, 47, 49, 52), and three the SOS-PD (21, 22, 42).…”

Delirium-The Effect of Children Anesthesiology after Surgery

“…There are several challenges associated with accurately and systematically diagnosing pediatric delirium. The gold standard for identifying delirium is a diagnosis by a child and adolescent psychiatrist based on criteria of the Diagnostic and Statistical Manual of Mental Disorders 6,7. Delirium in hospitalized children is characterized as hypoactive, hyperactive, or mixed.…”

“…Delirium occurs in infants as young as three months old and may not have upper or lower age limitations. In some instances, parents may describe their child's behavior as "this is not my child" and should be taken seriously because this behavior change may be an additional indication of delirium 7. Management of a child with delirium begins with identifying and modifying factors that contribute to the development of delirium in children, including hypoxia, medications such as anticholinergics and benzodiazepines, metabolic disturbances, pain, and anxiety.Anesthesia impact on emergency deliriumAnesthesia emergence delirium (AED) is a transient state of irritation and dissociation, which occurs after discontinuation of anesthesia in some patients and is not responsive to consolation.…”