The pharmacologic management of delirium in children and adolescents

Area of Science:

• Critical Care Medicine
• Pediatric Medicine
• Psychiatry

Background:

• Delirium is a prevalent and serious condition in critically ill patients across all age groups.
• Pediatric delirium is under-recognized and under-addressed, despite its significant impact.
• Current treatment relies on addressing underlying causes and managing symptoms, often with off-label medications.

Purpose of the Study:

• To review the current understanding and management strategies for delirium in children and adolescents.
• To highlight the shift in first-line antipsychotic choices for delirium symptom management.
• To explore emerging therapeutic agents for delirium.

Main Methods:

• Literature review of delirium management in pediatric and adult populations.
• Analysis of current guidelines and clinical practices for antipsychotic use in delirium.
• Examination of evidence for novel agents like melatonin and dexmedetomidine.

Main Results:

• Olanzapine, quetiapine, and risperidone are now preferred over haloperidol for managing delirium symptoms.
• Melatonin may help address sleep disturbances associated with delirium.
• Dexmedetomidine shows potential for reducing benzodiazepine and opioid requirements.

Conclusions:

• Effective delirium management requires addressing the root cause and judicious symptom control.
• The pharmacological approach to delirium is evolving, with newer agents offering potential benefits.
• Further research is needed to establish optimal treatment protocols for pediatric delirium.