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Published on: July 4, 2018
Opioid use is Associated with ICU Delirium in Mechanically Ventilated Children
Neha Gupta1, Allison Woolley2, Saurabh Talathi1
1University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Insights
Older age, higher opioid doses, and longer mechanical ventilation increase pediatric intensive care unit delirium risk. Identifying these factors aids in preventing delirium in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Neuroscience
- Pharmacology
Background:
- Pediatric delirium in the intensive care unit (ICU) is a significant clinical challenge.
- The pathophysiology is complex and multifactorial, with limited research on critically ill, sedated, and mechanically ventilated children.
Purpose of the Study:
- To identify factors associated with delirium in mechanically ventilated children within a pediatric ICU.
Main Methods:
- A single-center study in a tertiary care pediatric ICU included patients requiring >48 hours of sedation and mechanical ventilation.
- The Cornell Assessment of Pediatric Delirium scale screened for delirium.
- Logistic regression analyzed demographic, clinical, and medication dose factors (daily and cumulative opioids/benzodiazepines).
Main Results:
- 20% of 95 eligible patient visits resulted in a delirium diagnosis.
- Older patients (>12 years) had higher delirium odds.
- Increased daily (OR=1.977) and cumulative opioid doses (OR=1.035) were significantly associated with delirium.
- Duration of mechanical ventilation correlated with delirium development.
Conclusions:
- Age, opioid dosage (daily and cumulative), and duration of mechanical ventilation are key factors associated with delirium in mechanically ventilated pediatric ICU patients.
Introduction:
Pediatric delirium is a significant problem when encounterd in an intensive care unit (ICU). The pathophysiology of pediatric delirium is complex and the etiology is typically multifactorial. Even though various risk factors associated with pediatric delirium in a pediatric ICU have been identified, there is still a paucity of literature associated with the condition, especially in extremely critically ill children, sedated and mechanically ventilated.
Aim Of The Study:
To identify factors associated with delirium in mechanically ventilated children in an ICU.
Material And Methods:
This is a single-center study conducted at a tertiary care pediatric ICU. Patients admitted to the pediatric ICU requiring sedation and mechanical ventilation for >48 hours were included. Cornell Assessment of Pediatric Delirium scale was used to screen patients with delirium. Baseline demographic and clinical factors as well as daily and cumulative doses of medications were compared between patients with and without delirium. Firth's penalized maximum likelihood logistic regression was used on a priori set of variables to examine the association of potential factors with delirium. Two regression models were created to assess the effect of daily medication doses (Model 1) as well as cumulative medication doses (Model 2) of opioids and benzodiazepines.
Results:
95 patient visits met the inclusion criteria. 19 patients (20%) were diagnosed with delirium. Older patients (>12 years) had higher odds of developing delirium. Every 1mg/kg/day increase in daily doses of opioids was associated with an increased risk of delirium (OR=1.977, p=0.017). Likewise, 1 mg/kg increase in the cumulative opioid dose was associated with a higher odds of developing delirium (OR=1.035, p=0.022). Duration of mechanical ventilation was associated with the development of delirium in Model 1 (p=0.007).
Conclusions:
Age, daily and cumulative opioid dosage and the duration of mechanical ventilation are associated with the development of delirium in mechanically ventilated children.
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