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 The prevalence of delirium nearly doubles after five days in a
pediatric ICU, underscoring the need for routine monitoring of
children for it, researchers say.
"(The condition) is more common and more widespread than previously
recognized," Dr. Chani Traube, a pediatric intensivist from Weill
Cornell Medicine and New York-Presbyterian in New York City, said in
a statement. "Monitoring children for the development of delirium
should be a routine part of the care we provide, just as we monitor
children for the development of fevers when they are sick.”
“We need increased awareness about delirium in children in the ICU
in order to detect it early and treat it. It's much easier to treat
early delirium than it is to treat delirium that has been entrenched
for several days,” Traube noted in an interview with Reuters Health.
There is a large body of research about delirium in adult ICU
patients, but far less in pediatric critical care, she said.
Traube and her colleagues did their study at 25 pediatric ICUs in
the United States, the Netherlands, New Zealand, Australia and Saudi
Arabia. Nurses at these sites screened 994 children for delirium
with a test called the Cornell Assessment for Pediatric Delirium (CAPD).
Using this rapid bedside tool, delirium status could be established
in 835 cases, or 84 percent, according to the results in Critical
Care Medicine. Of the children whose status could be determined, 209
screened positive for delirium, 13 percent were classified as
comatose and 62 percent were delirium-free and coma-free.
The duration of children's stays in the pediatric ICU ranged from
two to nine days, with an average of six.
Delirium rates increased markedly after day five in the ICU, the
study found. For children in the ICU for less than six days, 20
percent experienced delirium. For those who were in the ICU for six
or more days, delirium prevalence was 38 percent, “which was really
eye-opening for me,” Traube said.
The prevalence of delirium varied significantly with reason for ICU
stay, with the highest delirium rates (42 percent) found in children
admitted with an infectious or inflammatory disorder.
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Other factors independently associated with delirium included age
younger than 2 years, mechanical ventilation, use of benzodiazepines
or narcotics, use of physical restraints and exposure to blood
pressure or antiepileptic drugs.
“There is significant opportunity for improvement in the ICU
environment and in our prescribing practices within that initial
five day period that might lead to a decrease in the emergence of
delirium,” Traube said.
“There absolutely are children that are higher risk for developing
delirium from the get-go; upon admission to the ICU they can be
identified and there are ICU practices that further contribute to
delirium,” she said.
This study supports the feasibility of using CAPD to screen for
delirium in the pediatric ICU, the researchers conclude in their
report.
“Most of the ICUs participating in our study don't routinely screen
for delirium, and they were able to do so without much difficulty in
nearly all their patients,” Traube said in her statement. “You don't
need to buy expensive equipment or do extensive training.”
SOURCE: http://bit.ly/2mNsT1W Critical Care Medicine, online March
10, 2017.
(This story has been refiled to change slug.)
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