Whats New in the Patient Safety World
August 2014
Delirium in Pediatrics
Virtually all our columns on delirium screening, diagnosis and management have focused on adult patients, particularly the elderly. However, recently there has been an interest kindled in recognition of delirium in pediatric patients.
One research group conducted a survey of pediatric intensivists regarding sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children (Kudchadkar 2014). They found that delirium screening was not practiced in 71% of respondents PICUs, and only 2% reported routine screening at least twice a day. Use of earplugs, eye masks, noise reduction, and lighting optimization for sleep promotion was uncommon. Only 27% of respondents reported having written sedation protocols. And though 70% of respondents worked in PICUs with sedation scoring systems, only 42% of those with access to scoring systems reported routine daily use for goal-directed sedation management. There was also considerable variation in the drugs used for sedation.
A viewpoint in the July issue of JAMA Pediatrics by Schieveld and Janssen (Schieveld 2014) called for growing recognition of pediatric delirium. Specifically, the authors recommend use of diagnostic criteria for pediatric delirium such as use of the Cornell Assessment of Pediatric Delirium tool (Traube 2014). The CAPD is a rapid observational screening tool recently validated in a pediatric ICU (PICU) setting and found to have an overall sensitivity of 94.1% and specificity of 79.2%. Interestingly, in their study population Traube and colleagues found the overall prevalence rate of delirium was 20.6%. So while not as high as the 60-80% prevalence typically seen in adult ICUs, it is clear that delirium is a common problem in pediatric critical care. The viewpoint article (Schieveld 2014) also noted the importance of inclusion of developmental anchor points to help in screening of very young children or those with developmental delay and called for use of flowcharts and continuous monitoring for delirium in the pediatric ICU patients.
Some of our prior
columns on delirium assessment and management:
·
October
21, 2008 Preventing
Delirium
·
October
14, 2009 Managing
Delirium
·
February
10, 2009 Sedation
in the ICU: The Dexmedetomidine Study
·
March
31, 2009 Screening
Patients for Risk of Delirium
·
June 23,
2009 More
on Delirium in the ICU
·
January
26, 2010 Preventing
Postoperative Delirium
·
August
31, 2010 Postoperative
Delirium
·
September
2011 Modified
HELP Helps Outcomes in Elderly Undergoing Abdominal Surgery
· December 2010 The ABCDE Bundle
·
February
28, 2012 AACN
Practice Alert on Delirium in Critical Care
·
April 3, 2012 New
Risk for Postoperative Delirium: Obstructive Sleep Apnea
·
August
7, 2012 Cognition,
Post-Op Delirium, and Post-Op Outcomes
·
September
2013 Disappointing
Results in Delirium
·
October
29, 2013 PAD:
The Pain, Agitation, and Delirium Care Bundle
·
February
2014 New
Studies on Delirium
·
March
25, 2014 Melatonin
and Delirium
·
May 2014
New
Delirium Severity Score
·
August
2014 A
New Rapid Screen for Delirium in the Elderly
References:
Kudchadkar SR, Yaster M, Punjabi NM. 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; 42(7): 1592-1600
Schieveld JNM, Janssen NJJF. Delirium in the Pediatric Patient. On the Growing Awareness of Its Clinical Interdisciplinary Importance. JAMA Pediatrics 2014; 168(7): 595-596
http://archpedi.jamanetwork.com/article.aspx?articleid=1867336
Traube C, Silver G, Kearney J, et al. Cornell Assessment of Pediatric Delirium: A Valid, Rapid, Observational Tool for Screening Delirium in the PICU. Critical Care Medicinem 2014; 42(3):656-663
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