Delirium is a Common and Early Finding in Patients in the Pediatric Cardiac Intensive Care Unit

作者：Alvarez Rita V^*; Palmer Claire; Czaja Angela S; Peyton Chris; Silver Gabrielle; Traube Chani; Mourani Peter M; Kaufman Jon

来源：Journal of Pediatrics, 2018, 195: 206-212.

DOI：10.1016/j.jpeds.2017.11.064

Objective To determine incidence, associated risk factors, and characteristics of delirium in a pediatric cardiac intensive care unit (CICU). Delirium is a frequent and serious complication in adults after cardiac surgery, but there is limited understanding of its impact in children with critical cardiac disease.
Study design Single-center prospective observational study of CICU patients <= 21 years old. All were screened for delirium using the Cornell Assessment for Pediatric Delirium each 12-hour shift.
Results Ninety-nine patients were included. Incidence of delirium was 57%. Median time to development of delirium was 1 day (95% CI 0, 1 days). Children with delirium were younger (geometric mean age 4 vs 46 months; P<.001), had longer periods of mechanical ventilation (mean 35.9 vs 8.8 hours; P=.002) and had longer cardiopulmonary bypass times (geometric mean 126 vs 81 minutes; P=.001). Delirious patients had longer length of CICU stay than those without delirium (median 3 (IQR 2, 12.5) vs 1 (IQR1, 2) days; P<.0001). A multivariable generalized linear mixed model showed a significant association between delirium and younger age (OR 0.35 for each additional month, 95% CI 0.19, 0.64), need for mechanical ventilation (OR 4.1, 95% CI 1.7, 9.89), and receipt of benzodiazepines (OR 3.78, 95% CI 1.46, 9.79).
Conclusions Delirium is common in patients in the pediatric CICU and is associated with longer length of stay. There may be opportunities for prevention of delirium by targeting modifiable risk factors, such as use of benzodiazepines.

• 出版日期2018-4