Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Crit Care Explor. 2024 Jul 5;6(7):e1119. doi: 10.1097/CCE.0000000000001119. eCollection 2024 Jul 1.
ICU delirium commonly complicates critical illness associated with factors such as cardiopulmonary bypass (CPB) time and the requirement of mechanical ventilation (MV). Recent reports associate hyperoxia with poorer outcomes in critically ill children. This study sought to determine whether hyperoxia on CPB in pediatric patients was associated with a higher prevalence of postoperative delirium.
Secondary analysis of data obtained from a prospective cohort study.
Twenty-two-bed pediatric cardiac ICU in a tertiary children's hospital.
All patients (18 yr old or older) admitted post-CPB, with documented delirium assessment scores using the Preschool/Pediatric Confusion Assessment Method for the ICU and who were enrolled in the Precision Medicine in Pediatric Cardiology Cohort from February 2021 to November 2021.
None.
Of 148 patients, who underwent cardiac surgery, 35 had delirium within the first 72 hours (24%). There was no association between hyperoxia on CPB and postoperative delirium for all definitions of hyperoxia, including hyperoxic area under the curve above 5 predetermined Pao2 levels: 150 mm Hg (odds ratio [95% CI]: 1.176 [0.605-2.286], p = 0.633); 175 mm Hg (OR 1.177 [95% CI, 0.668-2.075], p = 0.572); 200 mm Hg (OR 1.235 [95% CI, 0.752-2.026], p = 0.405); 250 mm Hg (OR 1.204 [95% CI, 0.859-1.688], p = 0.281), 300 mm Hg (OR 1.178 [95% CI, 0.918-1.511], p = 0.199). In an additional exploratory analysis, comparing patients with delirium within 72 hours versus those without, only the z score for weight differed (mean [sd]: 0.09 [1.41] vs. -0.48 [1.82], p < 0.05). When comparing patients who developed delirium at any point during their ICU stay (n = 45, 30%), MV days, severity of illness (Pediatric Index of Mortality 3 Score) score, CPB time, and z score for weight were associated with delirium (p < 0.05).
Postoperative delirium (72 hr from CPB) occurred in 24% of pediatric patients. Hyperoxia, defined in multiple ways, was not associated with delirium. On exploratory analysis, nutritional status (z score for weight) may be a significant factor in delirium risk. Further delineation of risk factors for postoperative delirium versus ICU delirium warrants additional study.
在与体外循环（CPB）时间和机械通气（MV）需求等因素相关的危重病患者中，ICU 谵妄很常见。最近的报告表明，在危重病儿童中，高氧血症与更差的预后相关。本研究旨在确定儿科患者 CPB 期间的高氧血症是否与更高的术后谵妄发生率相关。
对前瞻性队列研究中获得的数据进行二次分析。
三级儿童医院的 22 床儿科心脏 ICU。
所有在 CPB 后入院的患者（18 岁或以上），并使用 ICU 儿童和学前意识评估方法进行了记录的谵妄评估评分，并且在 2021 年 2 月至 2021 年 11 月期间参加了儿科心脏病精准医学队列。
无。
在接受心脏手术的 148 名患者中，有 35 名在最初的 72 小时内出现谵妄（24%）。在所有高氧血症定义中，CPB 期间的高氧血症与术后谵妄均无关联，包括 5 个预定的 PaO2 水平以上的高氧区面积：150 mmHg（比值比[95%CI]：1.176 [0.605-2.286]，p = 0.633）；175 mmHg（OR 1.177 [95%CI，0.668-2.075]，p = 0.572）；200 mmHg（OR 1.235 [95%CI，0.752-2.026]，p = 0.405）；250 mmHg（OR 1.204 [95%CI，0.859-1.688]，p = 0.281），300 mmHg（OR 1.178 [95%CI，0.918-1.511]，p = 0.199）。在一项额外的探索性分析中，比较 72 小时内发生谵妄的患者与未发生谵妄的患者，只有体重的 z 评分有所不同（均值[标准差]：0.09[1.41]与-0.48[1.82]，p < 0.05）。当比较在 ICU 期间任何时候发生谵妄的患者（n = 45，30%）时，MV 天数、疾病严重程度（儿科死亡率 3 分）评分、CPB 时间和体重的 z 评分与谵妄相关（p < 0.05）。
儿科患者术后谵妄（CPB 后 72 小时）发生率为 24%。高氧血症，以多种方式定义，与谵妄无关。在探索性分析中，营养状况（体重 z 评分）可能是谵妄风险的重要因素。需要进一步研究术后谵妄与 ICU 谵妄的危险因素。
