Argentine survey about delirium in pediatrics critical patients
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Abstract
Introduction: Delirium is an event associated with the care of the critically ill patient. Pediatric studies have shown that delirium is present in at least 25% of critically ill children and can be as high as 38% in children who stay in the PICU for more than 5 days. The tools validated for its correct detection are the Cornell Scale, PCAM ICU and psPCAM-ICU. There is no standardized treatment, its proper management is based on the prevention of modifiable risk factors.
Objective: To know concepts and practices of doctors and nurses who attend critically ill pediatric patients, in the diagnosis, management and prevention of delirium in Argentina.
Population and Methods: Doctors and nurses from the PICU of different provinces, through a survey distributed by email, during the year 2018.
Results: Of 170 doctors and nurses invited to participate, 113 responded. 85.32% consider delirium an expected event in the PICU, 87.16% that delirium is underdiagnosed and 90.27% that it is a situation that requires intervention. Only 12.38% received sufficient training. The most widely used scale was the Cornell scale, while the most used form of detection was the clinical examination of the treating physician. 65.48% consider the use of benzodiazepines useful for the treatment of delirium.
Conclusions: Delirium in the critically ill pediatric patient is considered an underdiagnosed event and requires intervention. The results highlight the need to improve delirium training in critically ill pediatric patients.
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References
2- Simone S, Edwards S, Lardieri A; Walker, et al. Implementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU. Pediatric Crit care. 2017; 18(6):531-540.
3- American Psychiatric Association: Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). American Psychiatric Association, Washington, DC, 2013.
4- Traube C, Silver G, Reeder RW, et al: Delirium in critically ill children: An international point prevalence study. Crit Care Med2017; 45:584–590.
5- Traube C, Silver G, Gerber LM, et al: Delirium and mortality in critically ill children: Epidemiology and outcomes of pediatric delirium. Crit Care Med2017; 45:891–898
6- Kudchadkar S, Yaster M, Punjabi N. Sedation, Sleep Promotion, and Delirium Screening Practices in the Care of Mechanically Ventilated Children: A Wake-up Call for the Pediatric Critical Care Community. Crit Care Med. 2014 July; 42(7): 1592– 1600.
7- Silver G, Kearney J, Traube C, Hertzig M. Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium. Palliative and Supportive Care (2015), 13, 1005–1011.
8- Smith H, Boyd J, Funchs C et al. Diagnosing delirium in critically ill children: validity and reliability of the pediatric confusion assessment method for the intensive care unit. Crit Care Med 2011;39(1): 150-157.
9- Traube C, Silver G, Kearney J. Cornell assessment of pediatric delirium: a valid, rapid, observational tool for screening delirium in the PICU. Crit Care Med 2014;42(3): 656-663.
10- Smith H, Gangopahyay M, Goben C et al. The preschool confusion assessment method for the ICU: valid and reliable delirium monitoring for critically III infants and children. Crit Care Med. 2016;44:592-600
11- Patel AK, Biagas KV, Clark EC, et al: Delirium in the pediatric cardiac extracorporeal membrane oxygenation patient population: A case series. Pediatr Crit Care Med 2017; 18:e621–e624
12-Tracie Walker, Sapna R, Kudchadkar: Pain and Sedation Management: 2018 Update for the Rogers’ Textbook of Pediatric Intensive Care. Pediatric Crit Care Med. 2019 Jan;20(1):54-61.
13- Smith HA, Boyd J, Fuchs DC, et al: Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit. Crit Care Med2011; 39:150– 157
14- Harris J, Ramelet AS, van Dijk M, et al: Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: An ESPNIC position statement for healthcare professionals. Intensive Care Med2016; 42:972–986
15- Sandra L. Staveski; Rita H. Pickler; Li Lin; Richard J. Shaw; Jareen Meinzen-Derr; Andrew Redington; Martha A. Q. Curley. Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices. Pediatr Crit Care Med 2018; 19:538–543.
16-Cooper Flaigle, Judy Ascenzi, Kudchadkar. Identifying Barriers to Delirium Screening and Prevention in the Pediatric ICU: Evaluation of PICU Staff Knowledge. J Pediatr Nurs. 2016 ; 31(1): 81–84.
17- Colville G, Kerry S, Pierce C et al. Children ́s factual and delusional memories of intensive care. Am J Respir Crit Care Med. 2008;177(9): 976-829.
18- Wade DM, Brewin CR, Howell DC, White E, et al. Intrusive memories of hallucinations and delusions in traumatized intensive care patients: An interview study. British Journal of Health Psychology. 2014. 20(3):613-31.
19- Svenningsen H, Tonnesen EK, Videbech P, Frydenberg M, et al.. Intensive care delirium - effect on memories and health-related quality of life - a follow-up study. Journal of Clinical Nursing. 2014. 23(5-6):634-44.
20-4- Smith H, Fuchs C, Pandharipande P et al. Delirium: an emerging frontier in the management of critically ill children. Crit Care Clin. 2009;25: 539-614
21- Mody K, Kaur S, Mauer EA, et al: Benzodiazepines and development of delirium in critically ill children: Estimating the causal effect. Crit Care Med 2018; 46:1486–1491
22- Pandharipande P, Shintani A, Peterson J et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104(1): 21-26.