Claire Christian, MD
Nationwide Children's Hospital At Ohio State University
Columbus, Ohio
Disclosure information not submitted.
Stephani Kim, Ph.D., M.P.H.
Research Scientist
Nationwide Children's Hospital, United States
Disclosure information not submitted.
Joseph Tobias, M.D.
Chief, Department of Anesthesiology & Pain Medicine
Nationwide Children's Hospital, United States
Disclosure information not submitted.
TITLE: Delirium in Pediatric Patients with Respiratory Insufficiency requiring Non-invasive Ventilation
Introduction: Delirium is associated with increased length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, and cost. Independent predictors of delirium include age < 2 years, developmental delay, severity of illness, mechanical ventilation, benzodiazepines, and anticholinergic medications. There are currently no published studies on delirium in children receiving non-invasive ventilation (NIV). Our primary aim was to investigate the incidence of delirium in PICU patients on NIV and evaluate potentially modifiable risk factors for delirium in this population.
Methods: This was a single center, retrospective study evaluating the incidence of delirium as established by the Cornell Assessment of Pediatric Delirium (CAPD). Delirium was defined as a CAPD score and we evaluated PICU patients 18 years old with respiratory insufficiency requiring 48 hours of NIV. We excluded patients with pre-existing tracheostomy, home oxygen, home invasive or non-invasive ventilation, and patients who were intubated and subsequently extubated to NIV.
Results: There were 202 patients that received 48 hours of NIV during our study period. Of those, 43 met inclusion criteria and had CAPD documentation while on NIV. The most common primary disease process was viral bronchiolitis (88%). There were 143 days on NIV in our cohort and a total of 106 days with CAPD documentation. The incidence of delirium was 67.4% and the median number of days with delirium was 2. There was no difference in hospital or PICU LOS between the two groups in our cohort, and all patients were weaned off NIV without requiring invasive mechanical ventilation. Sixty-nine percent of the patients who experienced delirium had received benzodiazepines, compared with 14% who did not experience delirium (p=0.001). The majority of our cohort received dexmedetomidine, so a sub-analysis was performed in this population. Similarly, of the patients who experienced delirium and received dexmedetomidine, 68% received benzodiazepines compared to 25% in the non-delirious group (p=0.046).
Conclusions: Delirium is common in young pediatric patients receiving NIV. As previously shown in the invasive mechanical ventilation population, benzodiazepine exposure continues to be a potentially modifiable risk factor for delirium in this population.