Delirium

CLINICAL PRACTICE GUIDELINES (FULL LIST)

DELIRIUM PATHWAY

BRAIN MAPS

Delirium is a syndrome of acute brain dysfunction that is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to include the presence of inattention and alteration from baseline mental status with secondary features that can include unawareness of surroundings, inconsolability, disorganized thinking/confusion/cognitive impairment, or sleep-wake cycle abnormalities. Delirium often manifests with a fluctuating course of severity and occurs as a direct physiologic consequence of a medical or surgical condition. Delirium is highly prevalent (reported rates up to 80%) across the spectrum of disease states in the pediatric medical, surgical, and cardiac intensive care units (ICU) and its development should be considered a possibility in all critically ill or decompensating hospitalized pediatric patients. Multiple studies have determined key risk factors for delirium in pediatric patients. “Predisposing risk factors” for delirium include younger age (< 2 years of age), baseline neurodevelopmental delay, poor nutritional status, and cyanotic heart disease. “Precipitating risk factors” include high severity of illness, excessive benzodiazepine or other sedative exposure associated with deep sedation, coma, requirement of prolonged mechanical ventilation (MV), and longer cardiopulmonary bypass time. Delirium in critically ill pediatric patients is associated with increases in hospital and ICU length of stay, longer duration of MV, greater hospital costs, and higher in-hospital mortality. As such, it is imperative to regularly screen for delirium with validated tools, practice preventative measures, and once diagnosed take prompt action to ameliorate inciting factors and employ evidence-based treatment strategies. This Clinical Practice Guideline serves as a framework for best practice regarding prevention, screening and treatment of pediatric delirium.

Authors

  • Heidi Smith (Professor Anesthesiology and Pediatrics)
  • Kristina Betters (Associate Professor Pediatrics - Medical Director PICU)
  • Allison Weatherly (Assistant Professor Pediatrics)
  • Stacey Williams (DNP Department of Pediatrics, Division critical care)
  • Cathy Fuchs (Professor Child & Adolescent Psychiatry)
  • Tasia York (Assistant Professor Child & Adolescent Psychiatry)
  • Alex Barry (RN, MBA, Department of Allergy, Pulmonary & Critical Care)
  • Julie Pingel (PharmD, Clinical Pharmacy Specialist-Pediatric Cardiac ICU)
  • Jessica Anderson (PharmD, Clinical Pharmacy Specialist-Pediatric ICU)