Prevalence of ICU Delirium in Postoperative Pediatric Cardiac Surgery Patients.

Sandra L Staveski
Rita H. Pickler
Philip R Khoury
Nicholas J Ollberding
Amy L Donnellan
Jennifer A Mauney
Patricia A Lincoln
Jennifer D Baird
Frances L Gilliland
Amber D Merritt
Laura B Presnell
Alexa R Lanese
Amy Jo Lisanti, Department of Cardiac Nursing and Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA
Belinda J Large
Lori D Fineman
Katherine H Gibson
Leigh A Mohler
Louise Callow
Sean S Barnes
Ruby L 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 E Peyton
Sandra K Hagstrom
Ashlee M Shields
Tracy Nye
T Christine E Alvarez
Lindsey B Justice
Seth T Kidwell
Andrew N Redington
Martha A Q Curley, 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.