Frequency and Causes of Delirium in Pediatric Intensive Care Unit: A Prospective Observational Study

Abstract

A bstract Background The number of studies evaluating delirium and its frequency in critically ill infants, children, and adolescents is increasing day by day. The primary objective of this study was to evaluate all patients hospitalized in our pediatric intensive care unit (PICU) in terms of pediatric delirium, to determine the frequency and risk factors of pediatric delirium. Patients and methods The patients included in this study had been hospitalized in the PICU between November 1, 2018, and August 31, 2019, and were followed up for more than 48 hours. Results Delirium was detected in 14 patients (9.9%) through regular evaluations. The Pediatric Index of Mortality 2 (PIM2) scores and the length of stay in the PICU were higher in patients with delirium ( p = 0.03 and p = 0.01, respectively). The use of respiratory support, sedation-analgesia, vasoactive and corticosteroid treatments, and physical restraints were higher in patients with delirium and were statistically significant ( p <0.05). Following admission to the PICU, psychosocial interventions were implemented for 76.1% of the whole cohort. Delirium developed in only five (4.5%) of the 108 patients who underwent psychosocial interventions, while it was detected in nine (26.5%) of the 34 patients who did not receive psychosocial interventions ( p = 0.001). The psychosocial intervention was associated with a lower likelihood of delirium (odds ratio [OR], 0.237; p = 0.044). An increasing number of days in the PICU was independently associated with increasing odds of delirium (OR, 1.095; p = 0.037 for each day). Conclusions We observed that the risk factors associated with delirium were similar to previous studies. Additionally, psychosocial intervention before delirium symptoms developed was associated with a lower risk of developing delirium. However, multicenter randomized controlled trials are needed on this subject. How to cite this article Yontem A, Yildizdas D, Horoz OO, et al. Frequency and Causes of Delirium in Pediatric Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2021;25(6):715–719.

Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis*

“…1 ). Thus, 24 articles (22–45) were included in our detailed analyses. The characteristics of the 24 pediatric cohort studies are summarized in Supplemental Digital Content 3 (http://links.lww.com/PCC/C331).…”

“…The children were from eight different countries; 63% were from the United States, and the rest were from other countries (e.g., Germany, The Netherlands, Brazil, Argentina, Turkey, China). The settings varied with 17 studies evaluating general PICU patients (23–29, 31–33, 35–37, 39, 41, 42, 44, 45), four studies evaluating pediatric cardiac ICU patients (22, 30, 34, 43), two studies evaluating patients after major surgery (26, 27), and three studies evaluating pediatric oncology patients (35, 38, 40). All 19 studies were of moderate to good methodological quality.…”

“…We know that preexisting dementia is linked to delirium in geriatric patients (39), and this observation is often linked to ACD load (47). We wondered whether this mechanism may be analogous to PD in children with baseline developmental disabilities (48).…”

“…In pooled analysis, physical restraints was associated with greater odds of PD (OR 4.67 [95% CI 1.82-11.96]) (Supplemental Digital Content 6, http://links.lww. com/PCC/C331) (24,30,31,34,37,39,43,44). We did not identify any differences in the overall effect between the PICU versus PCICU settings (Q = 2.96, p = 0.086).…”

“…lww.com/PCC/C331). However, the pooled analysis showed an association between use of steroids and greater odds of developing PD (OR 2.02 [95% CI 1.47-2.77]) (Table 1) (Supplemental Digital Content 6, http://links.lww.com/PCC/C331) (35)(36)(37)(38)(39)(40).…”