Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium.
Citations
93 citations
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64 citations
Cites background or methods or result from "Delirium and Mortality in Criticall..."
...hypoactive and mixed-type delirium were most common (46% and 45%, respectively), whereas the hyperactive subtype was only found in 8% of patients.(7) This profile of delirium is consistent with observations of adults with critical illnesses....
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...It is important to recognize that several risk factors are modifiable. factors associated with delirium – and delirium also causes increased LOS.7,25,33,34 To attempt to understand this relationship, an international study showed an increase in delirium rates after 5 days in the ICU (20% in children with LOS 5 days vs 38% in children with LOS >5 days, P<.001).39 Risk factors particular to children with congenital heart disease have been identified as well....
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...Furthermore, the few studies that have been conducted to assess the duration of delirium suggest it is a relatively brief condition, with a median of 2 days.(7,33,34) A substantial portion (approximately one-third) of patients with early onset delirium will demonstrate recurrent episodes during their ICU stay....
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...factors associated with delirium – and delirium also causes increased LOS.(7,25,33,34) To attempt to understand this relationship, an international study showed an increase in delirium rates after 5 days in the ICU (20% in children with LOS 5 days vs 38% in children with LOS >5 days, P<....
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...A prospective observational study (n 5 1540 children) used a multivariable model to demonstrate a 5-fold risk of delirium in children who were ever prescribed benzodiazepines (after controlling for severity of illness, developmental delay, mechanical ventilation, and other important confounders).(7) However, an assessment of the relationship between benzodiazepine use and delirium can be confounded by the fact that a child with hyperactive delirium could be prescribed benzodiazepines as a treatment of agitation....
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60 citations
Cites background or result from "Delirium and Mortality in Criticall..."
...In a handful of studies, PICU delirium is associated with adverse outcomes, including longer ICU stay and increased mortality (13, 17)....
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...In contrast to several adult and one pediatric study (13), we did not observe an independent association between delirium and mortality....
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References
3,005 citations
"Delirium and Mortality in Criticall..." refers background in this paper
...The first is the classification of delirium by subtype (hyperactive, hypoactive, and mixed), which has been intensively investigated in the adult literature(1,26,27)....
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...Delirium is a frequent and serious complication of critical illness, and has been linked to increased mortality, prolongation and complication of hospitalization, and long-term disability(1,2)....
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...Delirium Pathophysiology and Phenotype It is noteworthy that despite a prolific amount of research on delirium in adults, with thousands of articles published in peer-reviewed journals over the past decade, the pathophysiology is still incompletely understood, and there are few evidence-based treatment strategies(1)....
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...It is important to note that, as in adults, only a minority of delirium was of the easily recognizable hyperactive subtype(1,25,26)....
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2,784 citations
"Delirium and Mortality in Criticall..." refers background or methods in this paper
...Each child was assigned a daily status: “comatose” (patients with a Richmond Agitation Sedation Scale (RASS) score of −4 or −5, who are unarousable to verbal stimulation(10,11), and therefore impossible to assess for delirium), “delirious” (CAPD score ≥9 with diagnosis confirmed by physician), or “normal” mental status (i....
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...The RASS score ranges from −5 (unarousable), through 0 (alert and calm), to +4 (combative)(10)....
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...Individual patient data, including Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score(15) (after excluding neurologic component so as not to allow the presence of delirium to affect daily organ dysfunction score), RASS scores(10, 12), CAPD scores(8), need for respiratory support, and exposure to medications by categories (including narcotics, benzodiazepines, corticosteroids, anticholinergics, vasoactive medications, and neuroleptics), as well as other variables were collected daily....
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2,590 citations
2,411 citations
"Delirium and Mortality in Criticall..." refers background in this paper
...By avoiding precipitating factors, particularly in high-risk subgroups, we may be able to decrease the delirium burden in children(24)....
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1,379 citations
"Delirium and Mortality in Criticall..." refers methods in this paper
...Delirium subtype was determined by psychomotor activity and level of alertness, as assessed by the RASS, over the 24 hour period(11, 12)....
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...Each child was assigned a daily status: “comatose” (patients with a Richmond Agitation Sedation Scale (RASS) score of −4 or −5, who are unarousable to verbal stimulation(10,11), and therefore impossible to assess for delirium), “delirious” (CAPD score ≥9 with diagnosis confirmed by physician), or “normal” mental status (i....
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