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Vol. 43. Issue 3.
Pages 129-192 (April 2019)
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Vol. 43. Issue 3.
Pages 129-192 (April 2019)
Original
DOI: 10.1016/j.medine.2019.02.004
Clinical characteristics, prevalence, and factors related to delirium in children of 5 to 14 years of age admitted to intensive care
Características clínicas, prevalencia y factores asociados al delirium en niños de 5 a 14 años de edad ingresados en cuidados intensivos
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C. Ricardo Ramireza,
Corresponding author
carmenza.ricardo@upb.edu.co

Corresponding author.
, M.L. Álvarez Gómezb, C.A. Agudelo Véleza, S. Zuluaga Penagosa, R.A. Consuegra Peñaa, K. Uribe Hernándezb,c, I.C. Mejía Gilb, E.M. Cano Londoñob, M. Elorza Parrac, J.G. Franco Vásqueza
a Grupo de Investigación en Psiquiatría de Enlace, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
b Grupo de Investigación en Cuidado, Escuela de Ciencias de la Salud, Facultad de Enfermería, Universidad Pontificia Bolivariana, Medellín, Colombia
c Hospital Pablo Tobón Uribe, Medellín, Colombia
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Figures (1)
Tables (4)
Table 1. Sociodemographic and clinical characteristics of the 156 children with and without delirium in the critical care unit.
Table 2. Characteristics evaluated with the pCAM-ICU according to the motor type of delirium in the 29 children admitted to the critical care unit.
Table 3. Characteristics related to the diagnosis of delirium in 29 of 156 children admitted to the critical care unit. Univariate analysis.
Table 4. Multivariate logistic regression model of factors related to delirium in 29 of 156 children admitted to the critical care unit.
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Abstract
Objective

To evaluate the clinical characteristics, prevalence and factors associated with delirium in critical patients from 5 to 14 years of age.

Design

An analytical, cross-sectional observational study was made. Delirium was assessed with the Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) and motor classification was established with the Delirium Rating Scale Revised-98.

Setting

A pediatric Intensive Care Unit.

Patients

All those admitted over a one-year period were assessed during the first 24–72h, or when possible in deeply sedated patients. Exclusion criteria: Patients in stupor or coma, with severe communication difficulty, subjected to deep sedation throughout admission, and those with denied consent.

Results

Twenty-nine of the 156 assessed patients suffered delirium (18.6%) and 55.2% were hypoactive. The neurocognitive alterations evaluated by the pCAM-ICU were similar in the three motor groups. Intellectual disability (OR=17.54; 95%CI: 3.23–95.19), mechanical ventilation (OR=18.80; 95%CI: 4.29–82.28), liver failure (OR=54.88; 95%CI: 4.27–705.33), neurological disease (OR=4.41; 95%CI: 1.23–15.83), anticholinergic drug use (OR=3.23; 95%CI: 1.02–10.26), different psychotropic agents (OR=4.88; 95%CI: 1.42–16.73) and tachycardia (OR=4.74; 95%CI: 1.21–18.51) were associated to delirium according to the logistic regression analysis.

Conclusion

The frequency of delirium and hypoactivity was high. It is therefore necessary to routinely evaluate patients with standardized instruments. All patients presented with important neurocognitive alterations. Several factors related with the physiopathology of delirium were associated to the diagnosis; some of them are modifiable through the rationalization of medical care.

Keywords:
Delirium
Intellectual disability
Artificial respiration
Liver failure
Nervous system diseases
Cholinergic antagonists
Psychotropic drugs
Tachycardia
Pediatric intensive care units
Resumen
Objetivo

Evaluar las características clínicas, la prevalencia y los factores asociados al delirium en pacientes de entre 5 y 14 años de edad y en estado crítico.

Diseño

Estudio observacional analítico transversal. El delirium se evalúo con el Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) y la clasificación motora con la Delirium Rating Scale Revised-98.

Ámbito

Unidad de cuidados intensivos pediátricos.

Pacientes

Todos los que ingresaron durante un año fueron evaluados durante las primeras 24–72h o cuando fue posible si estaban en sedación profunda. Excluidos: pacientes en estupor o coma, con dificultad grave para la comunicación, en sedación profunda durante todo el ingreso y los que no contaban con consentimiento.

Resultados

Veintinueve (18,6%) de los 156 pacientes evaluados tenían delirium y el 55,2% eran hipoactivos. Las alteraciones neurocognitivas evaluadas por el pCAM-ICU fueron similares en los 3 grupos motores. La discapacidad intelectual (OR=17,54; IC95%: 3,23-95,19), la ventilación mecánica (OR=18,80; IC95%: 4,29-82,28), el fallo hepático (OR=54,88; IC95%: 4,27-705,33), las enfermedades neurológicas (OR=4,41; IC95%: 1,23-15,83), el uso de anticolinérgicos (OR=3,23; IC95%: 1,02-10,26), diversos tipos de psicotrópicos (OR=4,88; IC95%: 1,42-16,73) y la taquicardia (OR=4,74; IC95%: 1,21-18,51) se asociaron al delirium según el análisis logístico.

Conclusión

La frecuencia de delirium y del tipo hipoactivo es alta, por lo que es necesario evaluar rutinariamente los pacientes con instrumentos estandarizados. Todos los pacientes presentan alteración neurocognitiva importante. Varios factores relacionados con la fisiopatología del delirium se asocian al diagnóstico, algunos de los cuales son modificables mediante la racionalización de la atención médica.

Palabras clave:
Delirio
Discapacidad intelectual
Respiración artificial
Fallo hepático
Enfermedades del sistema nervioso
Antagonistas colinérgicos
Psicotrópicos
Taquicardia
Unidades de cuidados intensivos pediátricos

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