Traube Chani, Silver Gabrielle, Gerber Linda M, Kaur Savneet, Mauer Elizabeth A, Kerson Abigail, Joyce Christine, Greenwald Bruce M
1Department of Pediatrics, Weill Cornell Medical College, New York, NY. 2Department of Psychiatry, Weill Cornell Medical College, New York, NY. 3Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY. 4Weill Cornell Medical College, New York, NY. 5Department of Pediatrics, New York Presbyterian Hospital, New York, NY.
Crit Care Med. 2017 May;45(5):891-898. doi: 10.1097/CCM.0000000000002324.
Delirium occurs frequently in adults and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the frequency of delirium in critically ill children, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. Secondary objectives included determination of delirium subtype, and effect of delirium on duration of mechanical ventilation, and length of hospital stay.
Prospective, longitudinal cohort study.
Urban academic tertiary care PICU.
All consecutive admissions from September 2014 through August 2015.
Children were screened for delirium twice daily throughout their ICU stay.
Of 1,547 consecutive patients, delirium was diagnosed in 267 (17%) and lasted a median of 2 days (interquartile range, 1-5). Seventy-eight percent of children with delirium developed it within the first 3 PICU days. Most cases of delirium were of the hypoactive (46%) and mixed (45%) subtypes; only 8% of delirium episodes were characterized as hyperactive delirium. In multivariable analysis, independent predictors of delirium included age less than or equal to 2 years old, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics. PICU length of stay was increased in children with delirium (adjusted relative length of stay, 2.3; CI = 2.1-2.5; p < 0.001), as was duration of mechanical ventilation (median, 4 vs 1 d; p < 0.001). Delirium was a strong and independent predictor of mortality (adjusted odds ratio, 4.39; CI = 1.96-9.99; p < 0.001).
Delirium occurs frequently in critically ill children and is independently associated with mortality. Some in-hospital risk factors for delirium development are modifiable. Interventional studies are needed to determine best practices to limit delirium exposure in at-risk children.
谵妄在成人中频繁发生，是死亡率的独立预测因素。然而，儿童谵妄的流行病学和转归尚未得到充分描述。本研究的主要目的是描述危重症儿童谵妄的发生率、持续时间、相关危险因素以及对包括死亡率在内的院内转归的影响。次要目的包括确定谵妄亚型，以及谵妄对机械通气持续时间和住院时间的影响。
前瞻性纵向队列研究。
城市学术性三级医疗儿科重症监护病房。
2014年9月至2015年8月期间所有连续入院的患者。
在儿童入住重症监护病房期间，每天对其进行两次谵妄筛查。
在1547例连续患者中，267例（17%）被诊断为谵妄，中位持续时间为2天（四分位间距，1 - 5天）。78%的谵妄儿童在入住儿科重症监护病房的前3天内发生谵妄。大多数谵妄病例为活动减退型（46%）和混合型（45%）；只有8%的谵妄发作被归类为活动亢进型谵妄。在多变量分析中，谵妄的独立预测因素包括年龄小于或等于2岁、发育迟缓、疾病严重程度、既往昏迷、机械通气以及使用苯二氮䓬类药物和抗胆碱能药物。谵妄儿童的儿科重症监护病房住院时间延长（调整后的相对住院时间，2.3；可信区间 = 2.1 - 2.5；p < 0.001），机械通气持续时间也延长（中位时间，4天对1天；p < 0.001）。谵妄是死亡率的一个强有力的独立预测因素（调整后的优势比，4.39；可信区间 = 1.96 - 9.99；p < 0.001）。
谵妄在危重症儿童中频繁发生，且与死亡率独立相关。一些谵妄发生的院内危险因素是可以改变的。需要进行干预性研究以确定限制高危儿童发生谵妄的最佳措施。
