Benzodiazepines and Development of Delirium in Critically Ill Children: Estimating the Causal Effect.
Kalgi Mody,Savneet Kaur,Elizabeth Mauer,Linda M. Gerber,Bruce M. Greenwald,Gabrielle Silver,Chani Traube +6 more
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TLDR
Benzodiazepines are an independent and modifiable risk factor for development of delirium in critically ill children, even after carefully controlling for time-dependent covariates, with a dose-response effect.Abstract:
Objectives:Benzodiazepine use may be associated with delirium in critically ill children. However, benzodiazepines remain the first-line sedative choice in PICUs. Objectives were to determine the temporal relationship between administration of benzodiazepines and delirium development, control for tiread more
Citations
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Journal ArticleDOI
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
TL;DR: The current guidelines represent a comprehensive list of practical clinical recommendations for the assessment, prevention, and management of key aspects for the comprehensive critical care of infants and children, including pain, sedation/agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment, and early mobility as discussed by the authors .
Journal ArticleDOI
Delirium in a Tertiary PICU: Risk Factors and Outcomes
Leslie A. Dervan,Leslie A. Dervan,Jane L. Di Gennaro,Jane L. Di Gennaro,Reid W. D. Farris,Reid W. D. Farris,R. Scott Watson,R. Scott Watson +7 more
TL;DR: Delirium is common in the PICu, particularly among patients with length of stay greater than or equal to 48 hours, and is independently associated with patient characteristics and PICU exposures, including benzodiazepines.
Journal ArticleDOI
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.
Heidi A. B. Smith,James B. Besunder,Kristina Betters,Peter Johnson,Vijay Srinivasan,Anne Stormorken,Elizabeth Anne Farrington,Brenda Golianu,Aaron J. Godshall,Larkin Acinelli,Chris Almgren,Christine H Bailey,Jenny Boyd,Michael J. Cisco,Mihaela Damian,Mary DeAlmeida,James Fehr,Kimberly E. Fenton,Frances L. Gilliland,Mary Jo C. Grant,Joy D. Howell,Cassandra A Ruggles,Shari Simone,Felice Su,Janice E. Sullivan,Ken Tegtmeyer,Chani Traube,Stacey R. Williams,John W. Berkenbosch +28 more
TL;DR: The current guidelines represent a comprehensive list of practical clinical recommendations for the assessment, prevention, and management of key aspects for the comprehensive critical care of infants and children.
Journal ArticleDOI
Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation: Evaluation of Implementation and Efficacy to Reduce Withdrawal Syndrome.
Eva Sanavia,Santiago Mencía,Sarah N Lafever,Maria José Solana,Miriam García,Jesús López-Herce +5 more
TL;DR: In this article, a drug rotation protocol for critically ill children requiring prolonged sedation may reduce the appearance of withdrawal syndrome without increasing the risk of adverse effects and reduce the time of continuous IV infusions for most sedative and analgesic drugs.
Journal ArticleDOI
Prevalence of ICU Delirium in Postoperative Pediatric Cardiac Surgery Patients.
Sandra L. Staveski,Rita H. Pickler,Philip R. Khoury,Nicholas J. Ollberding,Amy Donnellan,Jennifer A. Mauney,Patricia Lincoln,Jennifer Baird,Frances L. Gilliland,Amber D. Merritt,Laura B. Presnell,Alexa R. Lanese,Amy Jo Lisanti,Belinda J. Large,Lori D. Fineman,Katherine H. Gibson,Leigh A. Mohler,Louise Callow,Sean Barnes,Ruby Whalen,Mary Jo C. Grant,Cathy Sheppard,Andrea M. Kline-Tilford,Page W. Steadman,Heidi C. Shafland,Karen M. Corlett,Serena P. Kelly,Laura A. Ortman,Christine Peyton,Sandra Hagstrom,Ashlee Shields,Tracy Nye,T. Christine E. Alvarez,Lindsey Justice,Seth T. Kidwell,Andrew N. Redington,Martha A. Q. Curley +36 more
TL;DR: Delirium is found to be a common problem after cardiac surgery with several important modifiable risk factors.
References
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Marginal Structural Models and Causal Inference in Epidemiology
TL;DR: In this paper, the authors introduce marginal structural models, a new class of causal models that allow for improved adjustment of confounding in observational studies with exposures or treatments that vary over time, when there exist time-dependent confounders that are also affected by previous treatment.
Journal ArticleDOI
Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit
Juliana Barr,Gilles L. Fraser,Kathleen Puntillo,E. Wesley Ely,Céline Gélinas,Joseph F. Dasta,Judy E. Davidson,John W. Devlin,John P. Kress,Aaron M. Joffe,Douglas B. Coursin,Daniel Herr,Avery Tung,Bryce R.H. Robinson,Dorrie K. Fontaine,Michael A. E. Ramsay,Richard R. Riker,Curtis N. Sessler,Brenda T. Pun,Yoanna Skrobik,Roman Jaeschke +20 more
TL;DR: These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
Journal ArticleDOI
Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit
E. Wesley Ely,Ayumi Shintani,Brenda Truman,Theodore Speroff,Sharon M. Gordon,Frank E. Harrell,Sharon K. Inouye,Gordon R. Bernard,Robert S. Dittus +8 more
TL;DR: Delirium was an independent predictor of higher 6-month mortality and longer hospital stay even after adjusting for relevant covariates including coma, sedatives, and analgesics in patients receiving mechanical ventilation.
Journal ArticleDOI
Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial
Pratik P. Pandharipande,Brenda T. Pun,Daniel Herr,Mervyn Maze,Timothy D. Girard,Russell R. Miller,Ayumi Shintani,Jennifer L. Thompson,James C. Jackson,Stephen A. Deppen,Renée A. Stiles,Robert S. Dittus,Gordon R. Bernard,E. Wesley Ely +13 more
TL;DR: In mechanically ventilated ICU patients managed with individualized targeted sedation, use of a dexmedetomidine infusion resulted in more days alive without delirium or coma and more time at the targeted level of sedation than with a lorazepam infusion.
Journal ArticleDOI
Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients.
Pratik P. Pandharipande,Ayumi Shintani,Josh F. Peterson,Brenda T. Pun,Grant R. Wilkinson,Robert S. Dittus,Gordon R. Bernard,E. Wesley Ely +7 more
TL;DR: Lorazepam administration is an important and potentially modifiable risk factor for transitioning into delirium even after adjusting for relevant covariates and increasing age and Acute Physiology and Chronic Health Evaluation II scores were also independent predictors of transitioning to delirity.
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