The purpose of this study was to investigate the prevalence and risk factors of delirium in children receiving mechanical ventilation (MV) admitted to the pediatric intensive care unit. A prospective observational study was conducted, enrolling 160 critically ill children aged 29 days to 18 years who received MV for more than 24 hr between August 2021 and August 2023. Delirium was assessed using the Cornell Assessment of Pediatric Delirium. Demographic, disease-related, and treatment-related characteristics were collected from electronic medical records by staff nurses. The incidence of delirium in children with MV was 83.8%. The median duration of MV at the onset of delirium was 1.5 (interquartile range: 0.5, 3.0) days, and according to the day of extubation, 74.6% of delirium cases first occurred ≥ 24 hr before extubation. Binary logistic regression analyses revealed that the independent risk factors of delirium in critically ill children with MV included age ≤ 5 years, physical restraints, pediatric sequential organ failure assessment score, and lower pulse oximetry oxygen saturation (SpO2). This study may help develop intervention strategies to reduce the incidence of delirium in critically ill children with MV by targeting related risk factors.
AlibrahimO.RehderK. J.MillerA. G.RottaA. T. (2022). Mechanical ventilation and respiratory support in the pediatric intensive care unit. Pediatric Clinics of North America, 69(3), 587–605. https://doi.org/10.1016/j.pcl.2022.02.004
2.
CloedtL. D.BenbouzidK.LavoieA.MetrasM.-É.LavoieM.-C.HarakatS.HarringtonK.Ducharme-CrevierL. (2022). The impact of implementing a “pain, agitation, and delirium bundle” in a pediatric intensive care unit: improved delirium diagnosis. Journal of Pediatric Intensive Care, 11(3), 233–239. https://doi.org/10.1055/s-0041-1723037
GeX.-H.WeiW.-R.FengT.-N.XuL.-L.HuY.-Q.YuanC.-R. (2021). Analysis of risk factor for pediatric intensive care unit delirium in children: A case-control study. American Journal of Translational Research, 13(8), 9143–9151. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430069/
5.
GuptaN.WoolleyA.TalathiS.DavlyatovG.ColstonC.HayesL. (2020). Opioid use is associated with ICU delirium in mechanically ventilated children. The Journal of Critical Care Medicine, 6(3), 167–174. https://doi.org/10.2478/jccm-2020-0026
6.
HassingerA. B.AfzalS.RauthM.BreuerR. K. (2023). Pediatric intensive care unit related sleep and circadian dysregulation: A focused review. Seminars in Pediatric Neurology, 48, 101077. https://doi.org/10.1016/j.spen.2023.101077
7.
HeS.MengY.LiuF.WangX.QiuH.ZuoZ. (2023). Nurses’ knowledge, attitude, and practice regarding the use of physical restraints in children in the intensive care setting in China: A cross-sectional multicentre study. Australian Critical Care, 36(4), 515–520. https://doi.org/10.1016/j.aucc.2022.04.007
8.
Henao-CastañoÁ. M.Motta-RobayoC. L.Rojas-RuizI. T. (2023). Incidence and factors associated with delirium in critically ill patients under 5 years old. Journal for Specialists in Pediatric Nursing, 28(3), e12412. https://doi.org/10.1111/jspn.12412
9.
HuangX.LeiL.ZhangS.YangJ.YangL.XuM. (2021). Implementation of the “awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility” bundle in the pediatric intensive care unit of tertiary hospitals in southwestern China: A cross-sectional survey. Journal of International Medical Research, 49(1), 030006052098777. https://doi.org/10.1177/0300060520987770
10.
IstaE.TraubeC.De NeefM.SchieveldJ.KnoesterH.MolagM.KudchadkarS. R.StrikJ., & on behalf of the Dutch Multidisciplinary Pediatric Delirium Guideline Group. (2023). Factors associated with delirium in children: A systematic review and meta-analysis. Pediatric Critical Care Medicine Journal, 24(5), 372–381. https://doi.org/10.1097/PCC.0000000000003196
11.
JeonK.JeongB.KoM. G.NamJ.YooH.ChungC. R.SuhG. Y. (2016). Impact of delirium on weaning from mechanical ventilation in medical patients. Respirology, 21(2), 313–320. https://doi.org/10.1111/resp.12673
12.
KalvasL. B.HarrisonT. M. (2020). State of the science in pediatric ICU delirium: An integrative review. Research in Nursing & Health, 43(4), 341–355. https://doi.org/10.1002/nur.22054
13.
KothA. M.ChanT.TjoengY. L.WatsonR. S.DervanL. A. (2022). Delirium in a tertiary pediatric cardiac intensive care unit: Risk factors and outcomes. Journal of Intensive Care Medicine, 37(10), 1328–1335. https://doi.org/10.1177/08850666211066892
14.
LeiL.LiY.XuH.ZhangQ.WuJ.ZhaoS.ZhangX.XuM.ZhangS. (2023). Incidence, associated factors, and outcomes of delirium in critically ill children in China: A prospective cohort study. BMC Psychiatry, 23(1), 925. https://doi.org/10.1186/s12888-023-05406-3
15.
LeiteM. A.OsakuE. F.CostaC. R. L. D. M.CândiaM. F.ToccoliniB.CovattiC.CostaN. L.NogueiraS. T.OgasawaraS. M.De AlbuquerqueC. E.PilattiC. M.PianaP. A.JorgeA. C.DuarteP. A. D. (2014). Delirium during weaning from mechanical ventilation. Critical Care Research and Practice, 2014, 546349. https://doi.org/10.1155/2014/546349
16.
LinS.-M.HuangC.-D.LiuC.-Y.LinH.-C.WangC.-H.HuangP.-Y.FangY.-F.ShiehM.-H.KuoH.-P. (2008). Risk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients. Journal of Critical Care, 23(3), 372–379. https://doi.org/10.1016/j.jcrc.2006.09.001
17.
MaticsT. J.Sanchez-PintoL. N. (2017). Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children. JAMA Pediatrics, 171(10), e172352. https://doi.org/10.1001/jamapediatrics.2017.2352
18.
MotwaniB.PandwarU.AgrawalA.ShrivastavaJ. (2022). Risk factors of delirium in children in pediatric intensive care unit. Indian Pediatrics, 59(11), 859–861. https://doi.org/10.1007/s13312-022-2643-x
19.
NewthC. J. L.KhemaniR. G.JouvetP. A.SwardK. A. (2017). Mechanical ventilation and decision support in pediatric intensive care. Pediatric Clinics of North America, 64(5), 1057–1070. https://doi.org/10.1016/j.pcl.2017.06.006
20.
PanY.JiangZ.YuanC.WangL.ZhangJ.ZhouJ.TaoM.QuanM.WuQ. (2018). Influence of physical restraint on delirium of adult patients in ICU: A nested case–control study. Journal of Clinical Nursing, 27(9–10), 1950–1957. https://doi.org/10.1111/jocn.14334
21.
PasinL.FebresD.TestaV.FratiE.BorghiG.LandoniG.ZangrilloA. (2015). Dexmedetomidine vs midazolam as preanesthetic medication in children: A meta-analysis of randomized controlled trials. Pediatric Anesthesia, 25(5), 468–476. https://doi.org/10.1111/pan.12587
22.
PeduzziP.ConcatoJ.KemperE.HolfordT. R.FeinsteinA. R. (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology, 49(12), 1373–1379. https://doi.org/10.1016/S0895-4356(96)00236-3
23.
QiuJ.YuanX.XuL.RuanZ.YangZ.GeX. (2024). Effects of prone position ventilation on delirium in patients with severe pneumonia. Military Nurses, 41(1), 51–55. https://doi.org/10.3969/i.issn.2097-1826.2024.01.013
24.
Rahimi-BasharF.AbolhasaniG.ManouchehrianN.JiryaeeN.Vahedian-AzimiA.SahebkarA. (2021). Incidence and risk factors of delirium in the intensive care unit: A prospective cohort. BioMed Research International, 2021, 6219678. https://doi.org/10.1155/2021/6219678
25.
SimoneS.EdwardsS.LardieriA.WalkerL. K.GracianoA. L.KishkO. A.CusterJ. W. (2017). Implementation of an ICU bundle: An interprofessional quality improvement project to enhance delirium management and monitor delirium prevalence in a single PICU. Pediatric Critical Care Medicine Journal, 18(6), 531–540. https://doi.org/10.1097/PCC.0000000000001127
26.
SmithH. A. B.BesunderJ. B.BettersK. A.JohnsonP. N.SrinivasanV.StormorkenA.FarringtonE.GolianuB.GodshallA. J.AcinelliL.AlmgrenC.BaileyC. H.BoydJ. M.CiscoM. J.DamianM.deAlmeidaM. L.FehrJ.FentonK. E.GillilandF.. . . BerkenboschJ. W. (2022). Society of critical care medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatric Critical Care Medicine Journal, 23(2), e74–e110. https://doi.org/10.1097/PCC.0000000000002873
27.
SosnowskiK.LinF.ChaboyerW.RanseK.HeffernanA.MitchellM. (2023). The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and meta-analysis. International Journal of Nursing Studies, 138, 104410. https://doi.org/10.1016/j.ijnurstu.2022.104410
28.
TraubeC.SilverG.GerberL. M.KaurS.MauerE. A.KersonA.JoyceC.GreenwaldB. M. (2017). Delirium and mortality in critically ill children: Epidemiology and outcomes of pediatric delirium. Critical Care Medicine, 45(5), 891–898. https://doi.org/10.1097/CCM.0000000000002324
29.
TraubeC.SilverG.KearneyJ.PatelA.AtkinsonT. M.YoonM. J.HalpertS.AugensteinJ.SicklesL. E.LiC.GreenwaldB. (2014). Cornell assessment of pediatric delirium: A valid, rapid, observational tool for screening delirium in the PICU. Critical Care Medicine, 42(3), 656–663. https://doi.org/10.1097/CCM.0b013e3182a66b76
30.
XuL.MaZ.QianW.XuY.ZhuY.ZhuX.GeX. (2024). Delirium in pediatric intensive care unit with mechanical ventilation: Analysis of incidence and influencing factors. Journal of Clinical Pediatrics, 42(5), 445–449. https://doi.org/10.12372/jcp.2024.23e0408
31.
XuT.ZhangW.FuC.JuM.LiuJ.YangX. (2022). Construction and application effect of delirium prevention nursing program in ICU children. Chinese Journal of Modern Nursing, 28(10), 1268–1274. https://doi.org/10.3760/cma.j.cn115682-20210901-03930
32.
XuT.ZhangY.YeX.FuC.LiY.JuM.LiuJ.YangX.ZhangW. (2023). Risk factors of delirium in a paediatric intensive care unit: A prospective case series study. Nursing in Critical Care, 28(5), 645–652. https://doi.org/10.1111/nicc.12920
33.
YangY.LiangS.GengJ.WangQ.WangP.CaoY.LiR.GaoG.LiL. (2020). Development of a nomogram to predict 30-day mortality of patients with sepsis-associated encephalopathy: A retrospective cohort study. Journal of Intensive Care, 8, 45. https://doi.org/10.1186/s40560-020-00459-y
34.
YuX.WangL.GaoY.XieZ.-X.LiG. (2022). Risk factors for delirium after sedation in children with convulsion and establishment of a nomogram model for predicting the risk of delirium. Chinese Journal of Contemporary Pediatrics, 24(11), 1238–1245. https://doi.org/10.7499/j.issn.1008-8830.2205076
35.
ZhangZ.PengC.YangX.WangY.ZhangY.ZhuX.LuG. (2022). The predictive value of dynamic monitoring pediatric sequential organ failure assessment score for the prognosis in children with sepsis. Chinese Pediatric Emergency Medicine, 29(9), 686–690. https://doi.org/10.3760/cma.j.issn.1673-4912.2022.09.005
36.
ZhuX.FengX.LinJ.DingY. (2022). Risk factors of delirium in paediatric intensive care units: A meta-analysis. PloS One, 17(7), e0270639. https://doi.org/10.1371/journal.pone.0270639
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