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[Delirium in critically ill children in a paediatric intensive care unit]
J N M Schieveld1, P L J M Leroy, A F G Leentjens
1Academisch Ziekenhuis Maastricht, Postbus 5800, 6202 AZ Maastricht. jan.schieveld@spsy.azm.nl
Insights
Critically ill children can develop delirium in the Paediatric Intensive Care Unit (PICU). Prompt recognition and treatment with haloperidol can effectively manage both hyperactive and hypoactive delirium in pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Child Neurology
- Pediatric Psychiatry
Background:
- Delirium is a significant concern in critically ill children, often underdiagnosed, especially the hypoactive subtype.
- Recognizing and managing pediatric delirium is crucial for improving patient outcomes in intensive care settings.
Observation:
- Two young girls in the Paediatric Intensive Care Unit (PICU) developed delirium: one with hyperactive delirium post-extubation for meningococcal meningitis, and another with hypoactive delirium due to cystic fibrosis exacerbation.
- The first child exhibited hyperactive delirium two hours after extubation, while the second presented with hypoactive delirium, regression, inconsolability, dyspraxia, and dysphasia.
Findings:
- Both pediatric patients with delirium showed a positive response to a single intravenous dose of haloperidol.
- Haloperidol is identified as a primary pharmacological treatment for delirium in critically ill children, with risperidone as a potential alternative.
Implications:
- Delirium in critically ill children, particularly the hypoactive form, requires prompt recognition and medical intervention.
- Despite physician reluctance, psychopharmacological treatment, including haloperidol, should be considered a medical emergency in the PICU setting.
Abstract:
Two critically ill girls, aged 2.3 years and 3.5 years respectively, developed delirium in the Paediatric Intensive Care Unit (PICU). The first child, admitted with meningococcal meningitis and septic shock with respiratory failure, suffered from hyperactive delirium which started 2 hours post-extubation. The second child, admitted due to an exacerbation of cystic fibrosis with the threat of respiratory failure, suffered from hypoactive delirium with regression, inconsolability, dyspraxia and dysphasia. Both patients responded well to a single intravenous dose of haloperidol. Although delirium occurs in critically ill children, it often goes unrecognized, particularly in its hypoactive form. It should nevertheless be considered as a medical emergency, particularly in a PICU setting, and should be treated accordingly. Physicians are generally reluctant to consider psychopharmacological treatment of childhood delirium. Haloperidol is considered as the drug of choice, but risperidone can also be used successfully.
