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Risk Factors for the Development of Postoperative Delirium in Pediatric Intensive Care Patients

Meyburg, Jochen MD1; Dill, Mona-Lisa1; von Haken, Rebecca MD2; Picardi, Susanne MD1,2; Westhoff, Jens Hendrik MD1; Silver, Gabrielle MD3; Traube, Chani MD4

Pediatric Critical Care Medicine: October 2018 - Volume 19 - Issue 10 - p e514-e521
doi: 10.1097/PCC.0000000000001681
Online Clinical Investigations

Objectives: To determine and quantify risk factors for postoperative pediatric delirium.

Design: Single-center prospective cohort study.

Setting: Twenty-two bed PICU in a tertiary care academic medical center in Germany.

Patients: All children admitted after major elective surgery (n = 93; 0–17 yr).

Interventions: After awakening, children were screened for delirium using the Cornell Assessment of Pediatric Delirium bid over a period of 5 days. Demographic and clinical data were collected from the initiation of general anesthesia.

Measurements and Main Results: A total of 61 patients (66%) were delirious. Younger children developed delirium more frequently, and the symptoms were more pronounced. The number of preceding operations did not influence the risk of delirium. Total IV anesthesia had a lower risk than inhalational anesthesia (p < 0.05). Duration of anesthesia was similar in all groups. Patients with delirium had a longer duration of mechanical ventilation in the PICU (p < 0.001). Significant differences in cumulative doses of various medications (e.g., sedatives, analgesics, and anticholinergics) were noted between groups; these differences were independent of disease severity. Invasive catheters and respiratory devices (p < 0.01) as well as infections (p < 0.001) increased risk of delirium.

Conclusions: A high prevalence of delirium was noted in the PICU, and several perioperative risk factors were identified. Our data may be a base for development of strategies to prevent and treat postoperative delirium in children.

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

2Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.

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

4Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY.

Dr. von Haken’s institution and she received funding from Orionpharma. Dr. Silver disclosed off-label product use of neuroleptic. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies