Delirium is a Common and Early Finding in Patients in the Pediatric Cardiac Intensive Care Unit
Abstract
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.
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Delirium prevalence is estimated to be as high as 49% to 57% in children with cyanotic disease, longer durations of mechanical ventilation, and long cardiopulmonary bypass times.
“Given that delirium pathophysiology is directly linked to the underlying medical condition, its prevalence is tightly related to the population under study, estimated to be as high as 49% to 57% in children with cyanotic disease, longer durations of mechanical ventilation, and long cardiopulmonary bypass times [67,68].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [67]
Anticholinergic drugs, benzodiazepines, opioids, immobilization, and restraints are among the modifiable risk factors for delirium.
“Anticholinergic drugs, benzodiazepines, opioids, immobilization, and restraints are among the modifiable risk factors for delirium [61,63,67,69].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [67]
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Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness
Nibras, S., Kentor, R., Masood, Y., Price, K., Schneider, N. M., Tenenbaum, R. B., & Calarge, C. (2022) · Children · doi:10.3390/children9071051 · Cited by 25 · see citing works
“Given that delirium pathophysiology is directly linked to the underlying medical condition, its prevalence is tightly related to the population under study, estimated to be as high as 49% to 57% in children with cyanotic disease, longer durations of mechanical ventilation, and long cardiopulmonary bypass times [67,68].”
Background
- Authors
- Alvarez, R. V., Palmer, C., Czaja, A. S., Peyton, C., Silver, G., Traube, C., Mourani, P. M., & Kaufman, J.
- Affiliations
- Medical College of Wisconsin (US)
- University of Colorado Anschutz (US)
- Children's Hospital Colorado (US)
- Weill Cornell Medicine (US)
- Corresponding author
- Alvarez, Rita V.
- ORCID
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 195
- Pages
- 206-212
- ISSN
- 0022-3476 (ISSN-L)
- OpenAlex
- W2791253526
- Cited by
- 147
- References
- 69
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 19 · 2023: 21 · 2022: 21 · 2021: 24 · 2020: 17 · 2019: 9 · 2018: 5
- FWCI
- 11.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pediatric Critical Care Clinical Research Program
- The Heart Institute of the Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- delirium, pediatric cardiac intensive care, incidence, risk factors, mechanical ventilation, cardiopulmonary bypass, benzodiazepines, length of hospital stay, critically ill children
- MeSH terms
- Adolescent, Child, Child, Preschool, Coronary Care Units, Delirium, Female, Heart Diseases, Humans, Infant, Infant, Newborn, Male, Prognosis, Prospective Studies, Risk Factors, Intensive Care Units, Pediatric, Incidence, Multivariate Analysis, Linear Models, Logistic Models, Young Adult
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