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Patterns of Postoperative Delirium in Children*

Meyburg, Jochen MD; Dill, Mona-Lisa; Traube, Chani MD; Silver, Gabrielle MD; von Haken, Rebecca MD

Pediatric Critical Care Medicine: February 2017 - Volume 18 - Issue 2 - p 128–133
doi: 10.1097/PCC.0000000000000993
Feature Articles

Objective: Intensive care delirium is a substantial problem in adults. Intensive care delirium is increasingly recognized in pediatrics in parallel with the development of specific scoring systems for children. However, little is known about the fluctuating course of intensive care delirium in children after surgery and possible implications on diagnostic and therapeutic strategies.

Design: Patients that needed treatment in the PICU following elective surgery were screened for intensive care delirium with the Cornell Assessment of Pediatric Delirium. When the patients were awake (Richmond Agitation and Sedation Score > -3), two trained investigators conducted the Cornell Assessment of Pediatric Delirium twice daily for five consecutive days.

Patients: Ninety-three patients aged 0 to 17 years.

Interventions: Eight hundred forty-five assessments completed.

Measurements and Main Results: Of the 845 scores, 230 were consistent with delirium (27.2%). Sixty-one patients (65.5%) were diagnosed with intensive care delirium. Half of these patients (n = 30; 32.2%) had a short-lasting delirium that resolved within 24 hours, and half (n = 31; 33.3%) had delirium of longer duration. Delirium could be clearly distinguished from sedation by analysis of individual test items of the Cornell Assessment of Pediatric Delirium. Time spent delirious had a measurable effect on outcome variables, including hospital length of stay.

Conclusion: Most postoperative PICU patients develop intensive care delirium. Some have a short-lasting course, which underlines the need for early screening. Our findings support the view of delirium as a continuum of acute neurocognitive disorder. Further research is needed to investigate prophylactic and treatment approaches for intensive care delirium.

1Department of General Pediatrics, University Children’s Hospital, Heidelberg, Germany.

2Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY.

3Department of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY.

4Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.

*See also p. 191.

>Drs. Traube and Silver received support for travel from Weill Cornell Medical College. Dr. Meyburg received support for travel from Heidelberg University Children’s Hospital. Dr. von Haken received funding from lectures on delirium in adults, and from Orionpharma; her institution received funding from Köhler Chemie. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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