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Lamoureux AA, Ducharme-Crevier L, Lacelle-Webster F, Jouvet P, Boivin J, Lavoie A, Rossignol E. Pediatric Delirium: An Overlooked Diagnosis? Pediatr Neurol 2023; 145:48-53. [PMID: 37271057 DOI: 10.1016/j.pediatrneurol.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 02/03/2023] [Accepted: 04/02/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Delirium is well-recognized in adult inpatient care. However, it is often overlooked in children, being mistaken for pain, anxiety, or age-appropriate agitation. METHODS To assess the impact of a formal teaching session on the diagnostic rates and management of pediatric delirium (PD) in a tertiary care center, we conducted a retrospective chart review of all hospitalized children diagnosed with PD between August 2003 and August 2018 at the CHU Sainte-Justine (Montreal, Canada). Diagnostic incidence and management were compared before (2003 to 2014) and after (2015 to 2018) a formal teaching session provided to pediatric residents, staff pediatricians, and intensive care physicians in December 2014. RESULTS The two cohorts displayed similar demographics, PD symptomatology, PD duration (median: 2 days), and hospital stay duration (median: 11.0 and 10.5 days). However, we saw a major increase in diagnosis frequency after 2014 (from 1.84 to 7.09 cases/year). This increased diagnostic rate was most striking in the pediatric intensive care unit setting. Although symptomatic treatment with antipsychotics and alpha-2 agonists was similar between the two cohorts, patients diagnosed after 2014 were more often weaned from offending medications (benzodiazepines, anesthetics, and anticholinergics). All patients recovered fully. CONCLUSIONS Formal teaching on the symptoms and management of PD was associated with an increase in diagnostic rate and an improved management of PD in our institution. Larger studies are required to assess standardized screening tools that may further enhance diagnostic rates and improve care for children with PD.
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Affiliation(s)
| | - Laurence Ducharme-Crevier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Fanny Lacelle-Webster
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Department of Pediatrics, CHU Sherbrooke, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Philippe Jouvet
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Johanne Boivin
- Department of Psychiatry, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Annie Lavoie
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Department of Pharmacy, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Elsa Rossignol
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Department of Neurosciences, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
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Valencia-Ramos J, Ochoa Sangrador C, García M, Oyagüez P, Arnaez J. Impact of different nebulisation systems on patient comfort in bronchiolitis: a randomised controlled cross-over trial. Arch Dis Child 2022; 107:1122-1127. [PMID: 36162958 DOI: 10.1136/archdischild-2021-323161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To test the hypothesis that greater comfort is achieved using a nebuliser integrated into a high-flow nasal cannula (nebulisation system integrated in high-flow nasal cannula (NHF)) than using a jet nebuliser (JN), and to explore differences in analgesia requirement and the possibility of feeding during nebulisation. DESIGN Randomised cross-over trial. SETTING Paediatric intensive care unit. PATIENTS Children aged <24 months diagnosed with bronchiolitis between November 2016 and May 2017. INTERVENTIONS Nebulisations using NHF and JN. MAIN OUTCOME MEASURES COMFORT-Behaviour Scale (CBS) and Numerical Rating Comfort Scale (NRSc) were used to measure comfort, and Numerical Rating Satisfaction Scale (NRSs) was used to assess satisfaction before, during and after nebulisation. Other variables included feeding, analgesia, need for being held and respiratory and heart rates. RESULTS Thirty-three children with 233 nebulisations were included in the study. The median age was 3.0 (IQR 2-9) months. Comfort and satisfaction were greater with NHF than with JN. The median staff-recorded CBS, NRSc and NRSs scores for NHF versus JN were 13 (IQR 9-15) vs 17 (IQR 13-23), 8 (IQR 7-0) vs 7 (IQR 4-8), and 4 (IQR 3-4) vs 2 (IQR 2-3), respectively; and caregiver-recorded scores were 12 (IQR 10-15) vs 19 (IQR 13-24), 9 (IQR 7-10) vs 4 (IQR 1-6), and 4 (IQR 3-4) vs 2 (IQR 1-3), respectively (p<0.001). Children who received NHF had lower cardiac and respiratory rates, needed to be held less often during therapy and required less analgesia (p<0.001). CONCLUSION Nebulisation through NHF appears to be a better alternative to JN in terms of comfort and satisfaction as well as making feeding possible during nebulisation.
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Affiliation(s)
- Juan Valencia-Ramos
- Paediatric Intensive Care Unit, Complejo Asistencial Universitario de Burgos, Burgos, Spain .,Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | - María García
- Paediatric Intensive Care Unit, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Pablo Oyagüez
- Paediatric Intensive Care Unit, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Juan Arnaez
- Neonatology, Complejo Asistencial Universitario de Burgos, Burgos, Spain.,Fundación NeNe, Burgos, Spain
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Skandalakis GP, Kalyvas A, Lani E, Komaitis S, Manolakou D, Chatzopoulou D, Pantazis N, Zenonos GA, Hadjipanayis CG, Stranjalis G, Koutsarnakis C. Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery. Brain Circ 2022; 8:207-214. [PMID: 37181839 PMCID: PMC10167845 DOI: 10.4103/bc.bc_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cerebral hyperperfusion syndrome (CHS) following bypass surgery is a major cause of neurological morbidity and mortality. However, data regarding its prevention have not been assorted until date. OBJECTIVE The objective of this study was to review the literature and evaluate whether any conclusion can be drawn regarding the effectiveness of any measure on preventing bypass-related CHS. METHODS We systematically reviewed PubMed and Cochrane Library from September 2008 to September 2018 to collect data regarding the effectiveness of pharmacologic interventions on the refers to pretreatment (PRE) of bypass-related CHS. We categorized interventions regarding their class of drugs and their combinations and calculated overall pooled estimates of proportions of CHS development through random-effects meta-analysis of proportions. RESULTS Our search yielded 649 studies, of which 23 fulfilled inclusion criteria. Meta-analysis included 23 studies/2,041 cases. In Group A (blood pressure [BP] control), 202 out of 1,174 pretreated cases developed CHS (23.3% pooled estimate; 95% confidence interval [CI]: 9.9-39.4), Group B (BP control + free radical scavenger [FRS]) 10/263 (0.3%; 95% CI: 0.0-14.1), Group C (BP control + antiplatelet) 22/204 (10.3%; 95% CI: 5.1-16.7), and Group D (BP control + postoperative sedation) 29/400 (6.8%; 95% CI: 4.4-9.6)]. CONCLUSIONS BP control alone has not been proven effective in preventing CHS. However, BP control along with either a FRS or an antiplatelet agent or postoperative sedation seems to reduce the incidence of CHS.
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Affiliation(s)
- Georgios P. Skandalakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Evgenia Lani
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Danai Manolakou
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva University Hospitals, Geneva, Switzerland
| | - Despoina Chatzopoulou
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios A. Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Constantinos G. Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Neurosurgery, Icahn School of Medicine Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY, USA
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Wang Y, Wu W, Zhang J, Sun J, Wang J, Hang Y, Wang Q, Duan P. Effect of intracutaneous pyonex on analgesia and sedation in critically ill patients with mechanical ventilation. Can J Physiol Pharmacol 2021; 100:78-85. [PMID: 34570990 DOI: 10.1139/cjpp-2021-0298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to evaluate the effect of intracutaneous pyonex on analgesia and sedation in critically ill patients who underwent mechanical ventilation. A total of 88 critically ill patients were divided into a control group and an intervention group. Critical Care Pain Observation Tool (CPOT) and Richmond Agitation and Sedation Scale (RASS) were used to evaluate pain and agitation. The dosage and treatment period of sedative and analgesic drugs in the intervention group were notably lower than the control group (p < 0.05). Analgesia compliance time in the intervention group was superior to control group (p < 0.05). The shallow sedation compliance rate in the intervention group was significantly higher than the control group (p < 0.01). There was significant difference in blood gas analysis before and after treatment between the two groups (p < 0.05). After 2 h of sedation and analgesia, heart rate in the intervention group was lower than control group, but respiratory rate was higher than the control group (p < 0.05). The traditional analgesia and sedation combined with intracutaneous pyonex reduced the total amount and treatment period of sedative and analgesic drugs in critically ill patients throughout the treatment process, and it also decreased the adverse reactions such as blood pressure drops and respiratory depression.
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Affiliation(s)
- Yuanyuan Wang
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China.,Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China
| | - Wenhua Wu
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China.,Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China
| | - Jie Zhang
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China.,Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China
| | - Jia Sun
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China.,Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China
| | - Jiling Wang
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China.,Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China
| | - Yongqing Hang
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China.,Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China
| | - Qianwen Wang
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China.,Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China
| | - Peibei Duan
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China.,Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210000, China
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5
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Lee LA, Moss SJ, Martin DA, Rosgen BK, Wollny K, Gilfoyle E, Fiest KM. Comfort-holding in critically ill children: a scoping review. Can J Anaesth 2021; 68:1695-1704. [PMID: 34405358 PMCID: PMC8370455 DOI: 10.1007/s12630-021-02090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022] Open
Abstract
Purpose To understand and summarize the breadth of knowledge on comfort-holding in pediatric intensive care units (PICUs). Sources This scoping review was conducted using PRISMA methodology. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials. Search strategies were developed with a medical librarian and revised through a peer review of electronic search strategies. All databases were searched from inception to 14 April 2020. Only full-text articles available in English were included. All identified articles were reviewed independently and in duplicate using predetermined criteria. All study designs were eligible if they reported on comfort-holding in a PICU. Data were extracted independently and in duplicate. Principal findings Of 13,326 studies identified, 13 were included. Comfort-holding was studied in the context of end-of-life care, developmental care, mobilization, and as a unique intervention. Comfort-holding is common during end-of-life care with 77.8% of children held, but rare during acute management (51% of children < three years, < 5% of children ≥ three years). Commonly reported outcomes included child outcomes (e.g., physiologic measurements), safety outcomes (e.g., accidental line removal), parent outcomes (e.g., psychological symptoms), and frequency of holding. Conclusion There is a paucity of literature on comfort-holding in PICUs. This scoping review identifies significant gaps in the literature, including assessment of child-based outcomes of comfort-holding or safety assessment of comfort-holding, and highlights core outcomes to consider in future evaluations of this intervention including child-based outcomes, parent-based outcomes, and safety of the intervention. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-021-02090-3.
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Affiliation(s)
- Laurie A Lee
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Faculty of Nursing, University of Calgary, Calgary, AB, Canada. .,Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Calgary, AB, T3B 6A8, Canada.
| | - Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Dori-Ann Martin
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada.,Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Calgary, AB, T3B 6A8, Canada
| | - Brianna K Rosgen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Elaine Gilfoyle
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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6
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Heo MH, Kim JY, Kim JH, Kim KW, Lee SI, Kim KT, Park JS, Choe WJ, Kim JH. Epidural analgesia versus intravenous analgesia after minimally invasive repair of pectus excavatum in pediatric patients: a systematic review and meta-analysis. Korean J Anesthesiol 2021; 74:449-458. [PMID: 34344147 PMCID: PMC8497911 DOI: 10.4097/kja.21133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. Methods We searched PubMed, MEDLINE, EMBASE, Cochrane Central Register, and ClinicalTrials.gov for randomized control trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay. Results Four RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in IV group. Epidural group showed lower VAS than IV group at 12 hours (mean difference -0.99 [95% CI: -1.52, -0.47], P = 0.001, I2 = 0%), at 24 hours (mean difference -0.65 [95% CI: -1.15, -0.16], P = 0.009, I2 = 0%), and 48 hours (mean difference -0.81 [95% CI: -1.61, -0.01], P = 0.046, I2 = 46%) after the surgery. Conclusion Epidural analgesia after the MIRPE had a better analgesic effect than IV analgesia from 12 hours to 48 hours after surgery, and AUC of VAS was lower in the epidural group. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.
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Affiliation(s)
- Min Hee Heo
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
| | - Jung Hyeon Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
| | - Kyung Woo Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
| | - Sang Il Lee
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
| | - Kyung-Tae Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
| | - Jang Su Park
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
| | - Won Joo Choe
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
| | - Jun Hyun Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi- do, Republic of Korea
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7
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Egbuta C, Mason KP. Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit. J Clin Med 2021; 10:1847. [PMID: 33922824 PMCID: PMC8122992 DOI: 10.3390/jcm10091847] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
Critically ill pediatric patients often require complex medical procedures as well as invasive testing and monitoring which tend to be painful and anxiety-provoking, necessitating the provision of analgesia and sedation to reduce stress response. Achieving the optimal combination of adequate analgesia and appropriate sedation can be quite challenging in a patient population with a wide spectrum of ages, sizes, and developmental stages. The added complexities of critical illness in the pediatric population such as evolving pathophysiology, impaired organ function, as well as altered pharmacodynamics and pharmacokinetics must be considered. Undersedation leaves patients at risk of physical and psychological stress which may have significant long term consequences. Oversedation, on the other hand, leaves the patient at risk of needing prolonged respiratory, specifically mechanical ventilator, support, prolonged ICU stay and hospital admission, and higher risk of untoward effects of analgosedative agents. Both undersedation and oversedation put critically ill pediatric patients at high risk of developing PICU-acquired complications (PACs) like delirium, withdrawal syndrome, neuromuscular atrophy and weakness, post-traumatic stress disorder, and poor rehabilitation. Optimal analgesia and sedation is dependent on continuous patient assessment with appropriately validated tools that help guide the titration of analgosedative agents to effect. Bundled interventions that emphasize minimizing benzodiazepines, screening for delirium frequently, avoiding physical and chemical restraints thereby allowing for greater mobility, and promoting adequate and proper sleep will disrupt the PICU culture of immobility and reduce the incidence of PACs.
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Affiliation(s)
| | - Keira P. Mason
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
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8
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Hong H, Guo C, Liu ZH, Wang BJ, Zhou SZ, Mu DL, Wang DX. The diagnostic threshold of Cornell assessment of pediatric delirium in detection of postoperative delirium in pediatric surgical patients. BMC Pediatr 2021; 21:87. [PMID: 33596858 PMCID: PMC7888127 DOI: 10.1186/s12887-021-02538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Abstract
Background Cornell assessment of pediatric delirium (CAPD) showed advantage in diagnosis of pediatric delirium in Chinese critically ill patients. But its performance in surgical patients is still unclear. The present study was designed to validate the diagnostic performance of CAPD in surgical pediatric patients. Methods This is a prospective validation study. Pediatric patients who underwent selective surgery and general anesthesia were enrolled. Primary outcome was the incidence of delirium within postoperative three days. CAPD Chinese version was used to evaluate if the patient had delirium one time per day. At the meantime, a psychiatrist employed Diagnostic and Statistical Manual of Mental Disorders fifth edition to diagnose delirium, which was the “gold standard”, and the result was considered as reference standard. Sensitivity, specificity and area under receiver operating characteristic (ROC) curve were calculated to investigate the performance of CAPD. Results A total of 170 patients were enrolled. Median age was 4 years old. As diagnosed by psychiatrist, 23 (13.5 %) patients experienced at least one episode of delirium during the follow-up period. When diagnostic threshold was set at 9, CAPD showed the optimal sensitivity (87.0 %, 95 %CI 65.3 %-96.6 %) and specificity (98.0 %, 95 %CI 93.7 %-99.5 %) in comparison with other diagnostic thresholds. ROC analysis showed that CAPD was a good delirium assessment instrument with area under curve of 0.911 (95 % CI 0.812 to 1.000, P < 0.001). Agreement between CAPD and reference standard was 0.849 (Kappa coefficient, P < 0.001). Conclusions This study found that Cornell assessment of pediatric delirium could be used as an effective instrument in diagnosis of delirium in pediatric surgical patients. Trial registration www.chictr.org.cn Identifier: ChiCTR-DDD-17,012,231, August 3, 2017.
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Affiliation(s)
- Hong Hong
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xi-Shi-Ku Street, Xi Cheng District, 100034, Beijing, China
| | - Chao Guo
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xi-Shi-Ku Street, Xi Cheng District, 100034, Beijing, China
| | - Zhi-Hua Liu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xi-Shi-Ku Street, Xi Cheng District, 100034, Beijing, China
| | - Bo-Jie Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xi-Shi-Ku Street, Xi Cheng District, 100034, Beijing, China.
| | - Shu-Zhe Zhou
- Department of Psychiatry, Peking University Sixth Hospital (Institute of Mental Health), No. 51, Hua-Yuan Road, Hai Dian District, 100191, Beijing, China.
| | - Dong-Liang Mu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xi-Shi-Ku Street, Xi Cheng District, 100034, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xi-Shi-Ku Street, Xi Cheng District, 100034, Beijing, China
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