Sandra L Staveski1, Rita H Pickler2, Philip R Khoury3, Nicholas J Ollberding4, Amy L Donnellan3, Jennifer A Mauney5, Patricia A Lincoln6, Jennifer D Baird7, Frances L Gilliland8, Amber D Merritt9, Laura B Presnell10, Alexa R Lanese11, Amy Jo Lisanti12, Belinda J Large13, Lori D Fineman14, Katherine H Gibson15, Leigh A Mohler16, Louise Callow17, Sean S Barnes18, Ruby L Whalen19, Mary Jo C Grant20, Cathy Sheppard21, Andrea M Kline-Tilford22, Page W Steadman23, Heidi C Shafland24, Karen M Corlett25, Serena P Kelly26, Laura A Ortman27, Christine E Peyton28, Sandra K Hagstrom29, Ashlee M Shields30, Tracy Nye31, T Christine E Alvarez32, Lindsey B Justice3, Seth T Kidwell3, Andrew N Redington33, Martha A Q Curley1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36. 1. University of California San Francisco, School of Nursing, San Francisco, CA. 2. The Ohio State University College of Nursing, Columbus, OH. 3. Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH. 4. Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. Department of Pediatrics, Critical Care¸ Baylor College of Medicine, Houston, TX. 6. Cardiac Intensive Care Unit, Department of Nursing, Boston Children's Hospital, Boston, MA. 7. Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA. 8. Cardiovascular Intensive Care Unit, Department of Nursing, John Hopkins All Children's Hospital, St. Petersburg, FL. 9. Cardiac Intensive Care Unit, Department of Nursing, Children's National Health Systems, Washington, DC. 10. Cardiovascular Intensive Care Unit, Department of Nursing, Lucile Packard Children's Hospital, Palo Alto, CA. 11. Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada. 12. Cardiac Nursing, Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA. 13. Division of Cardiovascular Intensive Care, Phoenix Children's Hospital, Phoenix, AZ. 14. Pediatric Intensive Care Unit, Department of Nursing, UCSF Benioff Children's Hospital, San Francisco, CA. 15. Cardiac Intensive Care Unit, Department of Nursing, Children's Healthcare of Atlanta, Atlanta, GA. 16. Cardiovascular Intensive Care Unit, Department of Nursing, Children's Hospital of Orange County, Orange, CA. 17. Pediatric Cardiac Surgery, Department of Nursing, Congenital Heart Center, Mott Children's Hospital, Ann Arbor, MI. 18. Department of Anesthesiology and Critical Care Medicine, John Hopkins Hospital, Baltimore, MD. 19. Cardiac Care Center, The Heart Program, Nicklaus Children's Hospital, Miami, FL. 20. Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, UT. 21. Pediatric Pulmonary Hypertension, Stollery Children's Hospital, Edmonton, AB, Canada. 22. Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, MI. 23. Cardiac Care Unit, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 24. Cardiovascular Intensive Care Unit, Department of Nursing, Children's Minnesota, Minneapolis, MN. 25. Cardiac Intensive Care Unit, Department of Nursing, Seattle Children's Hospital, Seattle, WA. 26. Pediatric Critical Care, Department of Nursing, Doernbecher Children's Hospital, Portland, OR. 27. Division of Critical Care, Department of Pediatrics, Omaha Children's Hospital and Medical Center, Omaha, NE. 28. Department of Nursing, Children's Hospital Heart Institute, Children's Hospital Colorado, Aurora, CO. 29. Pediatric Critical Care, Department of Nursing, University of Minnesota Masonic Children's Hospital, Minneapolis, MN. 30. Cardiac Intensive Care, Department of Nursing, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. 31. Department of Nursing, Advocate Children's Hospital, Oak Lawn, IL. 32. Research in Patient Services, Department of Nursing, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 33. Cardiology Clinic, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 34. Family and Community Health, Department of Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA. 35. Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 36. The Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA.
Abstract
OBJECTIVES: The objective of this study was to determine the prevalence of ICU delirium in children less than 18 years old that underwent cardiac surgery within the last 30 days. The secondary aim of the study was to identify risk factors associated with ICU delirium in postoperative pediatric cardiac surgical patients. DESIGN: A 1-day, multicenter point-prevalence study of delirium in pediatric postoperative cardiac surgery patients. SETTING: Twenty-seven pediatric cardiac and general critical care units caring for postoperative pediatric cardiac surgery patients in North America. PATIENTS: All children less than 18 years old hospitalized in the cardiac critical care units at 06:00 on a randomly selected, study day. INTERVENTIONS: Eligible children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the study team in collaboration with the bedside nurse. MEASUREMENT AND MAIN RESULTS: Overall, 181 patients were enrolled and 40% (n = 73) screened positive for delirium. There were no statistically significant differences in patient demographic information, severity of defect or surgical procedure, past medical history, or postoperative day between patients screening positive or negative for delirium. Our bivariate analysis found those patients screening positive had a longer duration of mechanical ventilation (12.8 vs 5.1 d; p = 0.02); required more vasoactive support (55% vs 26%; p = 0.0009); and had a higher number of invasive catheters (4 vs 3 catheters; p = 0.001). Delirium-positive patients received more total opioid exposure (1.80 vs 0.36 mg/kg/d of morphine equivalents; p < 0.001), did not have an ambulation or physical therapy schedule (p = 0.02), had not been out of bed in the previous 24 hours (p < 0.0002), and parents were not at the bedside at time of data collection (p = 0.008). In the mixed-effects logistic regression analysis of modifiable risk factors, the following variables were associated with a positive delirium screen: 1) pain score, per point increase (odds ratio, 1.3; 1.06-1.60); 2) total opioid exposure, per mg/kg/d increase (odds ratio, 1.35; 1.06-1.73); 3) SBS less than 0 (odds ratio, 4.01; 1.21-13.27); 4) pain medication or sedative administered in the previous 4 hours (odds ratio, 3.49; 1.32-9.28); 5) no progressive physical therapy or ambulation schedule in their medical record (odds ratio, 4.40; 1.41-13.68); and 6) parents not at bedside at time of data collection (odds ratio, 2.31; 1.01-5.31). CONCLUSIONS: We found delirium to be a common problem after cardiac surgery with several important modifiable risk factors.
OBJECTIVES: The objective of this study was to determine the prevalence of ICU delirium in children less than 18 years old that underwent cardiac surgery within the last 30 days. The secondary aim of the study was to identify risk factors associated with ICU delirium in postoperative pediatric cardiac surgical patients. DESIGN: A 1-day, multicenter point-prevalence study of delirium in pediatric postoperative cardiac surgery patients. SETTING: Twenty-seven pediatric cardiac and general critical care units caring for postoperative pediatric cardiac surgery patients in North America. PATIENTS: All children less than 18 years old hospitalized in the cardiac critical care units at 06:00 on a randomly selected, study day. INTERVENTIONS: Eligible children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the study team in collaboration with the bedside nurse. MEASUREMENT AND MAIN RESULTS: Overall, 181 patients were enrolled and 40% (n = 73) screened positive for delirium. There were no statistically significant differences in patient demographic information, severity of defect or surgical procedure, past medical history, or postoperative day between patients screening positive or negative for delirium. Our bivariate analysis found those patients screening positive had a longer duration of mechanical ventilation (12.8 vs 5.1 d; p = 0.02); required more vasoactive support (55% vs 26%; p = 0.0009); and had a higher number of invasive catheters (4 vs 3 catheters; p = 0.001). Delirium-positive patients received more total opioid exposure (1.80 vs 0.36 mg/kg/d of morphine equivalents; p < 0.001), did not have an ambulation or physical therapy schedule (p = 0.02), had not been out of bed in the previous 24 hours (p < 0.0002), and parents were not at the bedside at time of data collection (p = 0.008). In the mixed-effects logistic regression analysis of modifiable risk factors, the following variables were associated with a positive delirium screen: 1) pain score, per point increase (odds ratio, 1.3; 1.06-1.60); 2) total opioid exposure, per mg/kg/d increase (odds ratio, 1.35; 1.06-1.73); 3) SBS less than 0 (odds ratio, 4.01; 1.21-13.27); 4) pain medication or sedative administered in the previous 4 hours (odds ratio, 3.49; 1.32-9.28); 5) no progressive physical therapy or ambulation schedule in their medical record (odds ratio, 4.40; 1.41-13.68); and 6) parents not at bedside at time of data collection (odds ratio, 2.31; 1.01-5.31). CONCLUSIONS: We found delirium to be a common problem after cardiac surgery with several important modifiable risk factors.
Authors: Jörg Michel; Elena Schepan; Michael Hofbeck; Juliane Engel; Alexander Simma; Felix Neunhoeffer Journal: Front Pediatr Date: 2022-02-07 Impact factor: 3.418