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Delirium in Children After Cardiac Bypass Surgery*

Patel, Anita K. MD; Biagas, Katherine V. MD; Clarke, Eunice C. MSN, FNP-C; Gerber, Linda M. PhD; Mauer, Elizabeth MS; Silver, Gabrielle MD; Chai, Paul MD; Corda, Rozelle MSN, FNP; Traube, Chani MD

Pediatric Critical Care Medicine: February 2017 - Volume 18 - Issue 2 - p 165–171
doi: 10.1097/PCC.0000000000001032
Cardiac Intensive Care
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Objectives: To describe the incidence of delirium in pediatric patients after cardiac bypass surgery and explore associated risk factors and effect of delirium on in-hospital outcomes.

Design: Prospective observational single-center study.

Setting: Fourteen-bed pediatric cardiothoracic ICU.

Patients: One hundred ninety-four consecutive admissions following cardiac bypass surgery, 1 day to 21 years old.

Interventions: Subjects were screened for delirium daily using the Cornell Assessment of Pediatric Delirium.

Measurements and Main Results: Incidence of delirium in this sample was 49%. Delirium most often lasted 1–2 days and developed within the first 1–3 days after surgery. Age less than 2 years, developmental delay, higher Risk Adjustment for Congenital Heart Surgery 1 score, cyanotic disease, and albumin less than three were all independently associated with development of delirium in a multivariable model (all p < 0.03). Delirium was an independent predictor of prolonged ICU length of stay, with patients who were ever delirious having a 60% increase in ICU days compared with patients who were never delirious (p < 0.01).

Conclusions: In our institution, delirium is a frequent problem in children after cardiac bypass surgery, with identifiable risk factors. Our study suggests that cardiac bypass surgery significantly increases children’s susceptibility to delirium. This highlights the need for heightened, targeted delirium screening in all pediatric cardiothoracic ICUs to potentially improve outcomes in this vulnerable patient population.

1Department of Pediatric Critical Care, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.

2Department of Pediatric Critical Care, Columbia University College of Physicians and Surgeons, New York, NY.

3Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY.

4Department of Child Psychiatry, Weill Cornell Medical College, New York, NY.

5Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.

6Department of Surgery, Columbia School of Nursing, Columbia University College of Physicians and Surgeons, New York, NY.

7Department of Pediatric Critical Care, Weill Cornell Medical College, New York, NY.

*See also p. 196.

This study was performed at New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.

Dr. Gerber’s institution received funding (patent issued). Dr. Silver disclosed off-label product use of neuroleptic/antipsychotic medications that are used off label for symptoms of delirium. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: akp9009@nyp.org

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies