Opioid Use Is Associated with ICU Delirium in Mechanically Ventilated Children

Gupta, Neha; Woolley, Allison; Talathi, Saurabh; Davlyatov, Ganisher; Colston, Candice; Hayes, Leslie

doi:10.2478/jccm-2020-0026

Cited by 10 publications

(29 citation statements)

References 33 publications

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“…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).…”

Section: Resultsmentioning

confidence: 99%

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

Semple

Howlett

Strawbridge

et al. 2021

Critical Care Medicine

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Pediatric delirium is a neuropsychiatric disorder with disrupted cerebral functioning due to underlying disease and/or critical care treatment. Pediatric delirium can be classified as hypoactive, hyperactive, and mixed. This systematic review was conducted to estimate the pooled prevalence of pediatric delirium using validated assessment tools in children (Cornell Assessment of Pediatric Delirium, Pediatric Confusion Assessment Method for the ICU, PreSchool Confusion Assessment Method for the ICU, Pediatric Confusion Assessment Method for the ICU Severity Scale, and Sophia Observation Withdrawal Symptoms Pediatric Delirium scale), identify modifiable and nonmodifiable risk factors, and explore the association of pediatric delirium with clinical outcomes. DATA SOURCES:A systematic search of PubMed, EMBASE, and CINAHL databases was undertaken for full articles pertaining to pediatric delirium prevalence. STUDY SELECTION:No language or date barriers were set. Studies were included where the following eligibility criteria were met: study design aimed to estimate pediatric delirium prevalence arising from treatment in the intensive care setting, using a validated tool. Only randomized controlled trials, cross-sectional studies, or cohort studies allowing an estimate of the prevalence of pediatric delirium were included.DATA EXTRACTION: Data were extracted by the primary researcher (D.S.) and accuracy checked by coauthors. DATA SYNTHESIS:A narrative synthesis and pooled prevalence meta-analysis were undertaken. CONCLUSIONS:Pediatric delirium, as determined by the Cornell Assessment of Pediatric Delirium score, is estimated to occur in 34% of critical care admissions. Eight of 11 studies reporting on subtype identified hypoactive delirium as most prevalent (46-81%) with each of the three remaining reporting either hyperactive (44%), mixed (57%), or equal percentages of hypoactive and mixed delirium (43%) as most prevalent. The development of pediatric delirium is associated with cumulative doses of benzodiazepines, opioids, the number of sedative classes used, deep sedation, and cardiothoracic surgery. Increased time mechanically ventilated, length of stay, mortality, healthcare costs, and associations with decreased quality of life after discharge were also found. Multi-institutional and longitudinal studies are required to better determine the natural history, true prevalence, long-term outcomes, management strategies, and financial implications of pediatric delirium.

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Section: Resultsmentioning

confidence: 99%

“…A pooled PD prevalence of 34% (95% CI, 27–41) was estimated from 17 studies that reported prevalence per patient using CAPD ( Fig. 1 ) (36–38, 41, 43–46, 48, 50, 51, 54–59).…”

Section: Resultsmentioning

confidence: 99%

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

Semple

Howlett

Strawbridge

et al. 2021

Critical Care Medicine

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“…1 Although hospitalization in the PICU increases an individual's risk for delirium, we implemented this scale in a subset of the population at a higher risk of developing delirium. 16 To our knowledge, this is the first study assessing the performance of CAPD in this high-risk population.…”

Section: Discussionmentioning

confidence: 90%

Performance of Cornell Assessment of Pediatric Delirium Scale in Mechanically Ventilated Children

Gupta

Talathi

Woolley

et al. 2021

J Pediatr Intensive Care

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Accuracy of delirium diagnosis in mechanically ventilated children is often limited by their varying developmental abilities. The purpose of this study was to examine the performance of the Cornell Assessment of Pediatric Delirium (CAPD) scale in these patients. This is a single-center prospective observational study of patients requiring sedation and mechanical ventilation for 2 days or more. CAPD scale was implemented in our unit for delirium screening. Each CAPD assessment was accompanied by a physician assessment using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Sensitivity analysis was performed to determine the best cut-off score in our target population. We also evaluated ways to improve the accuracy of this scale in patients with and without developmental delay. A total of 837 paired assessments were performed. Prevalence of delirium was 19%. Overall, CAPD score ≥ 9 had sensitivity of 81.8% and specificity of 44.8%. Among typically developed patients, the sensitivity and specificity were 76.7 and 65.4%, respectively, whereas specificity was only 16.5% for developmentally delayed patients. The best cut-off value for CAPD was 9 for typically developed children and 17 for those with developmental delay (sensitivity 74.4%, specificity 63.2%). Some CAPD questions do not apply to patients with sensory and neurocognitive deficits; upon excluding those questions, the best cut-off values were 5 for typically developed and 6 for developmentally delayed children. In mechanically ventilated patients with developmental delay, CAPD ≥ 9 led to a high false-positive rate. This emphasizes the need for either a different cut-off score or development of a delirium scale specific to this patient population.

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“…26 In critically ill pediatric patients, high sound levels have been correlated with increased need for intermittent sedative boluses, and sedatives have been shown to increase risk of delirium in a dose-dependent fashion. 4,19,27 Furthermore, music therapy has been shown to physiologically reduce stress and anxiety, as well as reduce sedation and delirium severity in mechanically ventilated patients, suggesting an interplay between auditory processing, neuroinflammation, and deliriogenic neurotransmission. [28][29][30] Intermittent loud noises presumptively affect sleep quality and quantity, which we know to be diminished in pediatric critical illness.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, use of such medications has been associated with delirium. 4 27 43 Sleep–wake cycles vary as children grow, and infant sleep cycles are not yet mature. 44 Additionally, children thrive on adherence to routines, particularly in the context of medical care and their mental health.…”

Section: Discussionmentioning

confidence: 99%

Stuck in the Dark: No Association between Light, Sound, and Delirium in the PICU

Greenfield

Karam

O'Meara

2023

J Pediatr Intensive Care

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The purpose of this study was to evaluate the association between sound and light variables and development of delirium in pediatric intensive care unit (PICU) patients within the subsequent 3 days. Light and sound were continuously measured, and patient-specific data were collected daily. Outcomes included presence of delirium, determined by Cornell Assessment of Pediatric Delirium (CAPD) score ≥ 9 on at least 1 day, and development of delirium in the subsequent 3 days. One hundred and forty-two patients were enrolled, totaling 896 study days. Delirium prevalence was 31%. Neurologic diagnosis, younger age, longer PICU stay, restraints, benzodiazepines, opiate infusion, and dexmedetomidine were associated with delirium. Nighttime sound peaks (>70 and >80 dB) were not associated with delirium (p = 0.94 and 0.36, respectively). Light intensity during midday hours (12:00, 1:00, 2:00 pm) was not associated with the development of delirium (p=0.93, 0.81, 0.83, respectively), nor was maximum light at night, difference between maximum daytime and nighttime light, or between maximum and minimum daytime light (p = 0.15, 0.46, and 0.96, respectively). When adjusting for covariables, none of the sound or light variables was associated with delirium. Despite increasing awareness of pediatric delirium, data surrounding modifiable risk factors and concrete treatment strategies are lacking. We found no significant association between light or sound and development of delirium in PICU patients. However, there was little difference between daytime and nighttime light and sound, which may have impacted findings. As the etiology of delirium is multifactorial and potentially different for individual patients, targeted light/dark cycles warrant further study as they relate to delirium and critical illness.

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Opioid Use Is Associated with ICU Delirium in Mechanically Ventilated Children

Cited by 10 publications

References 33 publications

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

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

Performance of Cornell Assessment of Pediatric Delirium Scale in Mechanically Ventilated Children

Stuck in the Dark: No Association between Light, Sound, and Delirium in the PICU

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