Implementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU*

Simone, Shari; Edwards, Sarah; Lardieri, Allison; Walker, L. Kyle; Graciano, Ana Lía; Kishk, Omayma A.; Custer, Jason W.

doi:10.1097/pcc.0000000000001127

Cited by 108 publications

(72 citation statements)

References 31 publications

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“…Haloperidol is currently one of the most used antipsychotics for PD, although its efficacy for this indication is not proven [ 35 – 37 ]. There may be a larger role for nonpharmacological interventions than has been the case so far [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study

et al. 2018

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BackgroundsReports of increasing incidence rates of delirium in critically ill children are reason for concern. We evaluated the measurement properties of the pediatric delirium component (PD-scale) of the Sophia Observation Withdrawal Symptoms scale Pediatric Delirium scale (SOS-PD scale).MethodsIn a multicenter prospective observational study in four Dutch pediatric ICUs (PICUs), patients aged ≥ 3 months and admitted for ≥ 48 h were assessed with the PD-scale thrice daily. Criterion validity was assessed: if the PD-scale score was ≥ 4, a child psychiatrist clinically assessed the presence or absence of PD according to the Diagnostic and statistical manual of mental disorders (DSM)-IV. In addition, the child psychiatrist assessed a randomly selected group to establish the false-negative rate. The construct validity was assessed by calculating the Pearson coefficient (rp) for correlation between the PD-scale and Cornell Assessment Pediatric Delirium (CAP-D) scores. Interrater reliability was determined by comparing paired nurse-researcher PD-scale assessments and calculating the intraclass correlation coefficient (ICC).ResultsFour hundred eighty-five patients with a median age of 27.0 months (IQR 8–102) were included, of whom 48 patients were diagnosed with delirium by the child psychiatrist. The PD-scale had overall sensitivity of 92.3% and specificity of 96.5% compared to the psychiatrist diagnosis for a cutoff score ≥4 points. The rp between the PD-scale and the CAP-D was 0.89 (CI 95%, 0.82–0.93; p < 0.001). The ICC of 75 paired nurse-researcher observations was 0.99 (95% CI, 0.98–0.99).ConclusionsThe PD-scale has good reliability and validity for early screening of PD in critically ill children. It can be validly and reliably used by nurses to this aim.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2238-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study

et al. 2018

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“…Many studies have assessed associations between patient characteristics such as age, gender, severity of illness, reason for admission, and developmental delay in order to identify risk factors for development of delirium with varying results. Nine studies looked for associations between delirium and age with eight studies finding an association [5,15,19,20,21,22,23,24,25]. However, two found that delirium was associated with older age (>12 years) [19,20], while the other six found that delirium was associated with associated with younger age (<2, <5, or 2–5 years) [5,15,21,22,23,24].…”

Section: Delirium In Pediatric Intensive Care Unit Patientsmentioning

confidence: 99%

Section: Delirium In Pediatric Intensive Care Unit Patientsmentioning

confidence: 99%

“…Gender has been investigated in multiple studies; four studies found no association [5,20,21,22], with one study noting an association between the male gender and delirium [25]. Results have also been inconsistent with respect to severity of illness and delirium; three studies noted an association [23,24,26], but two found no association [25,27]. Pertaining to reason for admission, two studies found no association between reason for admission and delirium [5,20], while a study focusing on post-operative patients found a much higher incidence of delirium (66%) indicating that the post-operative status may be a risk factor for developing delirium [22].…”

Section: Delirium In Pediatric Intensive Care Unit Patientsmentioning

confidence: 99%

“…Respiratory failure requiring intubation and mechanical ventilator support is another risk factor for delirium independent of benzodiazepine exposure [5,15,20,21,24,25,30]. Traube et al found that of 29% of 642 patients that ever required mechanical ventilation developed delirium as compared to 9% of 905 patients with delirium who never received mechanical ventilation [24].…”

Section: Delirium In Pediatric Intensive Care Unit Patientsmentioning

confidence: 99%

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Sleep and Delirium in Pediatric Critical Illness: What Is the Relationship?

2018

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With growing recognition of pediatric delirium in pediatric critical illness there has also been increased investigation into improving recognition and determining potential risk factors. Disturbed sleep has been assumed to be one of the key risk factors leading to delirium and is commonplace in the pediatric critical care setting as the nature of intensive care requires frequent and invasive monitoring and interventions. However, this relationship between sleep and delirium in pediatric critical illness has not been definitively established and may, instead, reflect significant overlap in risk factors and consequences of underlying neurologic dysfunction. We aim to review the existing tools for evaluation of sleep and delirium in the pediatric critical care setting and review findings from recent investigations with application of these measures in the pediatric intensive care unit.

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State of the science in pediatric ICU delirium: An integrative review

Kalvas

Harrison

2020

Research in Nursing & Health

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Delirium is a complication of critical illness associated with poor outcomes. Although widely studied in adults, comparatively little is understood about delirium in pediatric intensive care units (ICUs). The purpose of this integrative review is to determine the extent and nature of current evidence, identify gaps in the literature, and outline future areas for investigation of pediatric ICU delirium. Eligible articles included research reports of delirium in pediatric ICU samples published in English since 2009. After an extensive literature search and consideration for inclusion/exclusion criteria, 22 articles were chosen for review. Delirium was highly prevalent in the ICU. Delirium episodes developed early in hospitalization, lasted several days, and consisted of hypoactive or mixed motor subtypes. Frequently identified independent risk factors included young age, developmental delay, mechanical ventilation, and benzodiazepine exposure. Pediatric delirium was independently associated with increased length of stay, costs, and mortality. The long‐term cognitive, psychological, and functional morbidities associated with pediatric delirium remain largely unknown. Few researchers have implemented interventions to prevent or manage delirium. There was little evidence for the efficacy or safety of pharmacological management. Multicomponent delirium bundles may significantly decrease delirium incidence. Key quality issues among studies included variation in delirium screening, low levels of evidence (i.e., observational studies), and limited ability to determine intervention efficacy in quasi‐experimental designs. Although the quantity and quality of pediatric delirium research has rapidly increased, further studies are needed to understand the long‐term effects of pediatric delirium and determine the efficacy and safety of interventions for prevention and management.

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Implementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU*

Abstract: Implementation of an ICU bundle along with staff education and case conferences is effective for improving delirium screening, detection, and treatment and is associated with decreased delirium prevalence.

Cited by 108 publications

References 31 publications

Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study

Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study

Sleep and Delirium in Pediatric Critical Illness: What Is the Relationship?

State of the science in pediatric ICU delirium: An integrative review

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