Delirium and Associated Risk Factors in Mechanically Ventilated Children: A Prospective Observational Study

Area of Science:

• Pediatric Critical Care Medicine
• Neuroscience
• Intensive Care Medicine

Background:

• Delirium is a significant concern in pediatric intensive care units.
• Mechanical ventilation (MV) is a common intervention for critically ill children.
• Understanding delirium prevalence and risk factors in this population is crucial for improving outcomes.

Purpose of the Study:

• To investigate the prevalence of delirium in children receiving mechanical ventilation (MV).
• To identify risk factors associated with delirium in critically ill children on MV.
• To inform the development of targeted intervention strategies.

Main Methods:

• Prospective observational study enrolling 160 children aged 29 days to 18 years receiving MV >24 hours.
• Delirium assessed using the Cornell Assessment of Pediatric Delirium.
• Data collected via electronic medical records, including demographics, disease, and treatment characteristics.

Main Results:

• The incidence of delirium in children on MV was high at 83.8%.
• Delirium onset occurred at a median of 1.5 days of MV, with 74.6% appearing ≥24 hours before extubation.
• Independent risk factors identified: age ≤ 5 years, physical restraints, pediatric sequential organ failure assessment score, and lower SpO2.

Conclusions:

• Delirium is highly prevalent in mechanically ventilated pediatric patients.
• Younger age, physical restraints, disease severity (pSOFA score), and hypoxemia are significant risk factors.
• Identifying these risk factors can guide the development of preventive and therapeutic strategies for pediatric delirium in the ICU.