Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit

Schieveld, Jan N. M.; Leroy, Piet L. J. M.; Os, Jim van; Nicolai, Joost; Vos, Gijs D.; Leentjens, Albert F.G.

doi:10.1007/s00134-007-0637-8

Cited by 175 publications

(191 citation statements)

References 28 publications

(23 reference statements)

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“…This way the child was categorized as having (probable) PD or not. The final diagnosis was made in a consensus meeting between child psychiatrist and paediatric intensivist, in order to rule out alternative diagnoses [9]. Diagnostic instruments for delirium, developed for the adult population (e.g.…”

Section: Design Setting and Patientsmentioning

confidence: 99%

“…Given the fact that the direct costs associated with a single day at the PICU are close to € 2.000 (source: financial control, Maastricht University Medical Center?, The Netherlands), these extra 2.39 days of intensive care would result in € 4.780 of extra costs. With a very conservatively estimated prevalence of PD of 5% [6,9] and 300 acute, non-elective admissions per year, 15 children with delirium would generate an extra cost of € 71.700 per year, corresponding to an increase of 1.5% in direct medical costs due to PD.…”

Section: Direct Costs Analysismentioning

confidence: 99%

“…Comparatively, little work has been carried out in the area of paediatric delirium (PD). Two studies reported incidences of 4 and 5% of PD in critically ill children in a paediatric intensive care unit (PICU) [6,9]. It is likely that these represent an underestimate, as case finding depended on referral for emotional and behavioural disturbances, as noticed during daily routine care.…”

Section: Introductionmentioning

confidence: 99%

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Prolonged stay at the paediatric intensive care unit associated with paediatric delirium

Smeets

Tan

Vossen

et al. 2009

Eur Child Adolesc Psychiatry

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The objective of this study was to investigate, under circumstances of routine care, the impact of paediatric delirium (PD) on length of stay in the paediatric intensive care unit (PICU) as well as on direct financial costs. A five-year prospective observational study (2002)(2003)(2004)(2005)(2006)(2007) was carried out in a tertiary eight-bed PICU in the Netherlands. Critically ill children aged 1 to 18 years who were acutely, non-electively and consecutively admitted to the PICU and detected as having PD in routine care were compared to critically ill children aged 1 to 18 years without signs of PD. PD, population characteristics and severity of illness at admission were used as predictors for length of PICU stay. Differences in length of stay yielded short-term, direct medical costs associated with PD. Fortynine children with and 98 children without PD were included. PD prolonged length of PICU stay with 2.39 days, independent of severity of illness, age, gender, mechanical ventilation and medical indication for admission (B = 0.38, P \ 0.001). PD increased direct medical costs with 1.5%. The results suggest a negative prognostic influence of PD on duration of PICU stay in routine care, resulting in an increase of direct medical costs.

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Section: Design Setting and Patientsmentioning

confidence: 99%

Section: Direct Costs Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prolonged stay at the paediatric intensive care unit associated with paediatric delirium

Smeets

Tan

Vossen

et al. 2009

Eur Child Adolesc Psychiatry

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“…Delirium symptoms are similar in adults and children, and may show slowed or sparse voice, slowed motor activity and lethargy in hypoactive type or aggressive, agitated, restless in hyperactive type. There is growing evidence of positive association between illness severity and paediatric delirium [14,15] .…”

Section: Deliriummentioning

confidence: 99%

A Practical Guide to Sedation and Analgesia in Paediatric Intensive Care Unit (Icu)

Upadhyay¹,

Tripathy²,

Kapoor³

et al. 2017

JAS

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All critically ill children have the right to adequate relief of their pain Correctable physical and environmental factors causing discomfort should be addressed using non-pharmacologic interventions before the initiation of pharmacologic interventions. The choice of sedative-analgesic agent and its initial dose are selected on the basis of several factors such as cause of the distress, desire depth and duration of therapy, clinical condition, potential drug interactions and pharmacokinetic modifying variables. Analgosedation: prioritize the use of analgesia first and then sedation should be the norm while starting sedative-analgesic and reverse to be followed in the weaning process. The level of sedation should be regularly assessed and documented using a sedation assessment scale, wherever possible using a validated scoring system such as the COMFORT scale Once the primary cause of ICU admission is treated, the sedative requirement should fall. Attempt should be made to reduce the level of sedation which require an individualised approach based on clinical condition, drug used for sedation-analgesia, total dose and duration of therapy. During reduction or withdrawal of sedative-analgesic, children should be closely observed for development of withdrawal symptoms.

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“…Among the adult population, the incidence is particularly high in geriatric patients [1]. In paediatric patients, similarly high rates of psychiatric disorder, mainly mood disorder and delirium, are observed, with reported rates of 5-40% [2,3]. Targeted pharmacological interventions may be used for primary and secondary prevention, but a common-sense population approach towards prevention in the form of extensive psychosocial interventions may be more productive, particularly in high-risk paediatric intensive care unit (PICU) settings [3][4][5].…”

mentioning

confidence: 99%

Pets or meds: how to tackle misery in a paediatric intensive care unit

Vos

Leroy

et al. 2007

Intensive Care Med

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Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit

Abstract: Objective: To study the phenomenology, clinical correlates, and response to treatment of delirium in critically ill children in the pediatric intensive care unit (PICU). Design, setting and patients:

Cited by 175 publications

References 28 publications

Prolonged stay at the paediatric intensive care unit associated with paediatric delirium

Prolonged stay at the paediatric intensive care unit associated with paediatric delirium

A Practical Guide to Sedation and Analgesia in Paediatric Intensive Care Unit (Icu)

Pets or meds: how to tackle misery in a paediatric intensive care unit

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