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Delirium Assessment Treatment Strategies in Critically Ill Pediatric Patients: A Pediatric Pharmacy Association
Caitlyn V Bradford1, Mon-Yee Fung2, Alexander Wang3
1Department of Pharmacy Practice (CVB), Philadelphia College of Pharmacy, Saint Joseph's University, Philadelphia, PA.
Insights
Most pediatric intensive care units lack a delirium protocol. Treatment and monitoring practices for pediatric delirium vary significantly across neonatal, cardiac, and pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Clinical pharmacy
- Neuroscience
Background:
- Pediatric delirium is a serious condition affecting critically ill children.
- Standardized screening, prevention, and treatment protocols are crucial for effective management.
- Variability in current practices may impact patient outcomes.
Purpose of the Study:
- To assess current practices for pediatric delirium management in various intensive care units.
- To determine the prevalence of defined delirium protocols among Pediatric Pharmacy Association members.
- To identify common assessment tools, treatments, and monitoring strategies for pediatric delirium.
Main Methods:
- A cross-sectional questionnaire survey was distributed to Pediatric Pharmacy Association members.
- Data were collected from February 8 to March 25, 2022.
- Chi-square tests were used for statistical comparisons between neonatal intensive care units (NICUs), cardiac intensive care units (CICUs), and pediatric intensive care units (PICUs).
Main Results:
- 84 respondents from 62 institutions participated, representing NICUs, CICUs, and PICUs.
- 72.6% of units routinely screen for delirium, with significant differences in tool usage across units (p < 0.01).
- Only 39.3% of units have a defined delirium protocol (p = 0.31). Quetiapine and risperidone were common treatments, with varied monitoring practices, though ECG monitoring was frequent.
Conclusions:
- A significant gap exists in the implementation of defined pediatric delirium protocols across intensive care settings.
- Substantial variability in delirium treatment and monitoring practices necessitates further standardization.
- These findings highlight the need for evidence-based guidelines to improve pediatric delirium care.
Objectives:
The purpose of this study was to describe overall screening, prevention, and treatments for pediatric delirium at various neonatal intensive care units (NICUs), cardiac intensive care units (CICUs), and pediatric intensive care units (PICUs) from the Pediatric Pharmacy Association (PPA) membership. The primary objective was to identify the number of respondents that had a defined delirium-based protocol. The secondary objectives included identification of delirium assessment tools used, first- and second-line delirium treatment options, and monitoring practices for antipsychotics for delirium management.
Methods:
A cross-sectional questionnaire was distributed to PPA members from February 8, 2022, to March, 25, 2022. Comparisons between the NICUs, PICUs, and CICUs were conducted by using chi-square tests, with a priori p value of <0.05.
Results:
The questionnaire was completed by 84 respondents at 62 institutions; respondents practiced in the PICU or mixed PICU (n = 48; 57.1%), CICU (n = 13; 15.5%), and NICU (n = 23; 27.4%). Sixty-one respondents (72.6%) noted their units routinely screen for delirium, and there was a significant difference between the respondents of different units that use a delirium scoring tool (p < 0.01). Only 33 respondents (39.3%) had a defined delirium protocol, and there was no difference between units (p = 0.31). The most common agents used for delirium treatment were quetiapine and risperidone. There was variability in the monitoring used between respondents, but the majority (n = 74; 88%) monitor electrocardiograms to assess the corrected QT interval, but practice variability existed.
Conclusions:
Most respondents did not have a defined delirium protocol. Variations were noted in the treatment options and monitoring for critically ill pediatric patients with delirium.
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