Pediatric Delirium. Monitoring and Management in the Pediatric Intensive Care Unit.

Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University, 2200 Childrens Way, 3116 VCH, Nashville, TN 37232, USA. Electronic address: .
Pediatric Clinics of North America (Impact Factor: 2.12). 06/2013; 60(3):741-60. DOI: 10.1016/j.pcl.2013.02.010
Source: PubMed


This review article updates the pediatric medical community on the current literature regarding diagnosis and treatment of delirium in critically ill children. This information will be of value to pediatricians, intensivists, and anesthesiologists in developing delirium monitoring and management protocols in their pediatric critical care units.

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    • "The etiology of pediatric delirium is multifactorial. It is often triggered by the underlying disease, exacerbated by the iatrogenic effects of treatment, and compounded by the unusual environment of the critical care unit (Schieveld et al. 2007; Creten et al. 2011; Smith et al. 2013). As an example, consider a 4-year-old child admitted with sepsis. "
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    ABSTRACT: Objective: Quetiapine is an atypical antipsychotic that has been used off-label for the treatment of intensive care unit (ICU) delirium in the adult population, with studies demonstrating both efficacy and a favorable safety profile. Although there is a potential role for quetiapine in the treatment of pediatric ICU delirium, there has been no systematic reporting to date of safety in this patient population. Methods: Pharmacy records were used to identify 55 consecutive pediatric ICU patients who were diagnosed with delirium and received quetiapine. A comprehensive retrospective medical chart review was performed to collect data on demographics, dosing, and side effects. Results: Fifty patients treated between January 2013 and November 2014 were included, and five patients were excluded from the study. Subjects ranged in age from 2 months to 20 years. Median daily dose was 1.3 mg/kg/day, and median duration of treatment was 12 days. There were three episodes of QTc prolongation that were clinically nonsignificant with no associated dysrhythmia: Two resolved over time without intervention, and one resolved with decrease in quetiapine dosage. There were no episodes of extrapyramidal symptoms or neuroleptic malignant syndrome. Conclusions: In this population of critically ill youth, short-term use of quetiapine as treatment for delirium appears to be safe, without serious adverse events. Further research is required to assess efficacy and evaluate for long-term effects. A prospective, randomized, placebo-controlled study of quetiapine in managing pediatric delirium is necessary.
    Journal of child and adolescent psychopharmacology 10/2015; 25(9). DOI:10.1089/cap.2015.0093 · 2.93 Impact Factor
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    • "It was designed as such to account for (1) a lack of baseline information if the parent was not available at the time of screening , often a limitation and obstacle for accurate assessment of mental status and behaviors in children , and (2) fluctuating mental status over the shift, a hallmark of delirium. Designed as an observational tool, the CAPD benefits from the patient– caregiver interaction (Smith et al., 2013), as the bedside nurse is usually the person with the most cumulative knowledge and experience of the patient on that day. This can be contrasted to the PAED, which was developed for use by an anesthesia nurse accompanying a waking patient postanesthesia. "
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    ABSTRACT: Objective: The recently validated Cornell Assessment for Pediatric Delirium (CAPD) is a new rapid bedside nursing screen for delirium in hospitalized children of all ages. The present manuscript provides a "developmental anchor points" reference chart, which helps ground clinicians' assessment of CAPD symptom domains in a developmental understanding of the presentation of delirium. Method: During the development of this CAPD screening tool, it became clear that clinicians need specific guidance and training to help them draw on their expertise in child development and pediatrics to improve the interpretative reliability of the tool and its accuracy in diagnosing delirium. The developmental anchor points chart was formulated and reviewed by a multidisciplinary panel of experts to evaluate content validity and include consideration of sick behaviors within a hospital setting. Results: The CAPD developmental anchor points for the key ages of newborn, 4 weeks, 6 weeks, 8 weeks, 28 weeks, 1 year, and 2 years served as the basis for training bedside nurses in scoring the CAPD for the validation trial and as a multifaceted bedside reference chart to be implemented within a clinical setting. In the current paper, we discuss the lessons learned during implementation, with particular emphasis on the importance of collaboration with the bedside nurse, the challenges of establishing a developmental baseline, and further questions about delirium diagnosis in children. Significance of results: The CAPD with developmental anchor points provides a validated, structured, and developmentally informed approach to screening and assessment of delirium in children. With minimal training on the use of the tool, bedside nurses and other pediatric practitioners can reliably identify children at risk for delirium.
    Palliative and Supportive Care 08/2014; 13(4):1-7. DOI:10.1017/S1478951514000947 · 0.98 Impact Factor
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    ABSTRACT: Medically ill adolescents are at increased risk for psychological distress and/or functional impairment. However, there are few research studies examining the optimal psychiatric treatments for this population. Psychiatric medication recommendations are largely based on studies of youth with a primary psychiatric disorder, adult studies, hypothesized mechanisms of action, and/or clinical experience. This paper provides evidence-informed recommendations for the psychopharmacological treatment of acutely medically ill adolescents suffering from significant psychological distress and/or functional impairment. Representing the most common problems among medically ill adolescents that are treated with psychiatric medications, recommendations are provided for anxiety and depression; iatrogenic medical trauma, inadequate sleep and insomnia; and, delirium.
    Current Psychiatry Reports 10/2013; 15(10):395. DOI:10.1007/s11920-013-0395-y · 3.24 Impact Factor
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