Delirium: an emerging frontier in the management of critically ill children.
ABSTRACT Delirium is a syndrome of acute brain dysfunction that commonly occurs in critically ill adults and most certainly is prevalent in critically ill children all over the world. The dearth of information about the incidence, prevalence, and severity of pediatric delirium stems from the simple fact that there have not been well-validated instruments for routine delirium diagnosis at the bedside. This article reviewed the emerging solutions to this problem, including description of a new pediatric tool called the pCAM-ICU. In adults, delirium is responsible for significant increases in both morbidity and mortality in critically ill patients. The advent of new tools for use in critically ill children will allow the epidemiology of this form of acute brain dysfunction to be studied adequately, will allow clinical management algorithms to be developed and implemented following testing, and will present the necessary incorporation of delirium as an outcome measure for future clinical trials in pediatric critical care medicine.
- Pediatric Critical Care Medicine 10/2014; 15(8):771-3. · 2.33 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Although our understanding of children's psychological outcomes following intensive care lags significantly behind advances in medicine, there is a growing awareness that intensive care admission impacts children beyond the boundaries of physical well-being. Intensive care presents a variety of disease-related, treatment-related, and environment-related stressors that may place children at risk of post-traumatic stress (PTS), particularly as children may have limited resources to understand and cope with aspects of the admission, its consequences, or treatment events. This article summarises the current literature on children's PTS responses following intensive care admission with emphasis on: (1) children's experience of intensive care; (2) the prevalence of PTS in children following intensive care admission; (c) factors associated with vulnerability to PTS; and (d) the role of memory and appraisal in the development of children's PTS. Existing research does have methodological limitations, and future studies utilising larger sample sizes and developmentally appropriate diagnostic measures are warranted. Furthermore, longitudinal studies investigating the aetiology and course of PTS following paediatric intensive care unit admission, particularly with further investigation of memory and cognitive factors, may lead to advances in screening, prevention, and early intervention strategies for children.Clinical Psychologist 03/2012; 16(1):1-14. · 0.43 Impact Factor
- [Show abstract] [Hide abstract]
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. · 3.05 Impact Factor