Delirium and Associated Risk Factors in Mechanically Ventilated Children: A Prospective Observational Study

Abstract

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.

Keywords

delirium mechanical ventilation pediatric intensive care unit risk factors

Get full access to this article

View all access options for this article.

References

Alibrahim

Rehder

K. J.

Miller

A. G.

Rotta

A. 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

Cloedt

L. D.

Benbouzid

Lavoie

Metras

M.-É.

Lavoie

M.-C.

Harakat

Harrington

Ducharme-Crevier

(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

Dechnik

Traube

(2020). Delirium in hospitalised children. The Lancet Child & Adolescent Health, 4(4), 312–321. https://doi.org/10.1016/S2352-4642(19)30377-3

X.-H.

Wei

W.-R.

Feng

T.-N.

L.-L.

Y.-Q.

Yuan

C.-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/

Gupta

Woolley

Talathi

Davlyatov

Colston

Hayes

(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

Hassinger

A. B.

Afzal

Rauth

Breuer

R. 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

Meng

Liu

Wang

Qiu

Zuo

(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

Henao-Castaño

Á. M.

Motta-Robayo

C. L.

Rojas-Ruiz

I. 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

Huang

Lei

Zhang

Yang

(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.

Ista

Traube

De Neef

Schieveld

Knoester

Molag

Kudchadkar

S. R.

Strik

, & 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.

Jeon

Jeong

M. G.

Nam

Yoo

Chung

C. R.

Suh

G. 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.

Kalvas

L. B.

Harrison

T. 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.

Koth

A. M.

Chan

Tjoeng

Y. L.

Watson

R. S.

Dervan

L. 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.

Lei

Zhang

Zhao

Zhang

(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.

Leite

M. A.

Osaku

E. F.

Costa

C. R. L. D. M.

Cândia

M. F.

Toccolini

Covatti

Costa

N. L.

Nogueira

S. T.

Ogasawara

S. M.

De Albuquerque

C. E.

Pilatti

C. M.

Piana

P. A.

Jorge

A. C.

Duarte

P. A. D.

(2014). Delirium during weaning from mechanical ventilation. Critical Care Research and Practice, 2014, 546349. https://doi.org/10.1155/2014/546349

16.

Lin

S.-M.

Huang

C.-D.

Liu

C.-Y.

Lin

H.-C.

Wang

C.-H.

Huang

P.-Y.

Fang

Y.-F.

Shieh

M.-H.

Kuo

H.-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.

Matics

T. J.

Sanchez-Pinto

L. 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.

Motwani

Pandwar

Agrawal

Shrivastava

(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.

Newth

C. J. L.

Khemani

R. G.

Jouvet

P. A.

Sward

K. 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.

Pan

Jiang

Yuan

Wang

Zhang

Zhou

Tao

Quan

(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.

Pasin

Febres

Testa

Frati

Borghi

Landoni

Zangrillo

(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.

Peduzzi

Concato

Kemper

Holford

T. R.

Feinstein

A. 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.

Qiu

Yuan

Ruan

Yang

(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-Bashar

Abolhasani

Manouchehrian

Jiryaee

Vahedian-Azimi

Sahebkar

(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.

Simone

Edwards

Lardieri

Walker

L. K.

Graciano

A. L.

Kishk

O. A.

Custer

J. 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.

Smith

H. A. B.

Besunder

J. B.

Betters

K. A.

Johnson

P. N.

Srinivasan

Stormorken

Farrington

Golianu

Godshall

A. J.

Acinelli

Almgren

Bailey

C. H.

Boyd

J. M.

Cisco

M. J.

Damian

deAlmeida

M. L.

Fehr

Fenton

K. E.

Gilliland

. . . Berkenbosch

J. 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.

Sosnowski

Lin

Chaboyer

Ranse

Heffernan

Mitchell

(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.

Traube

Silver

Gerber

L. M.

Kaur

Mauer

E. A.

Kerson

Joyce

Greenwald

B. 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.

Traube

Silver

Kearney

Patel

Atkinson

T. M.

Yoon

M. J.

Halpert

Augenstein

Sickles

L. E.

Greenwald

(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.

Qian

Zhu

(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.

Zhang

Liu

Yang

(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.

Zhang

Liu

Yang

Zhang

(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.

Yang

Liang

Geng

Wang

Cao

Gao

(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.

Wang

Gao

Xie

Z.-X.

(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.

Zhang

Peng

Yang

Wang

Zhang

Zhu

(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.

Zhu

Feng

Lin

Ding

(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

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB