Características clínicas, prevalencia y factores asociados al delirium en niños de 5 a 14 años de edad ingresados en cuidados intensivos / Clinical characteristics, prevalence, and factors related to delirium in children of 5 to 14 years of age admitted to intensive care

Objetivo: Evaluar las características clínicas, la prevalencia y los factores asociados al delirium en pacientes de entre 5 y 14 años de edad y en estado crítico. Diseño: Estudio observacional analítico transversal. El delirium se evalúo con el Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) y la clasificación motora con la Delirium Rating Scale Revised-98. Ámbito: Unidad de cuidados intensivos pediátricos. Pacientes: Todos los que ingresaron durante un año fueron evaluados durante las primeras 24-72h o cuando fue posible si estaban en sedación profunda. Excluidos: pacientes en estupor o coma, con dificultad grave para la comunicación, en sedación profunda durante todo el ingreso y los que no contaban con consentimiento. Resultados: Veintinueve (18,6%) de los 156 pacientes evaluados tenían delirium y el 55,2% eran hipoactivos. Las alteraciones neurocognitivas evaluadas por el pCAM-ICU fueron similares en los 3 grupos motores. La discapacidad intelectual (OR=17,54; IC95%: 3,23-95,19), la ventilación mecánica (OR=18,80; IC95%: 4,29-82,28), el fallo hepático (OR=54,88; IC95%: 4,27-705,33), las enfermedades neurológicas (OR=4,41; IC95%: 1,23-15,83), el uso de anticolinérgicos (OR=3,23; IC95%: 1,02-10,26), diversos tipos de psicotrópicos (OR=4,88; IC95%: 1,42-16,73) y la taquicardia (OR=4,74; IC95%: 1,21-18,51) se asociaron al delirium según el análisis logístico. Conclusión: La frecuencia de delirium y del tipo hipoactivo es alta, por lo que es necesario evaluar rutinariamente los pacientes con instrumentos estandarizados. Todos los pacientes presentan alteración neurocognitiva importante. Varios factores relacionados con la fisiopatología del delirium se asocian al diagnóstico, algunos de los cuales son modificables mediante la racionalización de la atención médica

Objective: To evaluate the clinical characteristics, prevalence and factors associated with delirium in critical patients from 5 to 14 years of age. Design: An analytical, cross-sectional observational study was made. Delirium was assessed with the Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) and motor classification was established with the Delirium Rating Scale Revised-98. Setting: A pediatric Intensive Care Unit. Patients: All those admitted over a one-year period were assessed during the first 24-72h, or when possible in deeply sedated patients. Exclusion criteria: Patients in stupor or coma, with severe communication difficulty, subjected to deep sedation throughout admission, and those with denied consent. Results: Twenty-nine of the 156 assessed patients suffered delirium (18.6%) and 55.2% were hypoactive. The neurocognitive alterations evaluated by the pCAM-ICU were similar in the three motor groups. Intellectual disability (OR=17.54; 95%CI: 3.23-95.19), mechanical ventilation (OR=18.80; 95%CI: 4.29-82.28), liver failure (OR=54.88; 95%CI: 4.27-705.33), neurological disease (OR=4.41; 95%CI: 1.23-15.83), anticholinergic drug use (OR=3.23; 95%CI: 1.02-10.26), different psychotropic agents (OR=4.88; 95%CI: 1.42-16.73) and tachycardia (OR=4.74; 95%CI: 1.21-18.51) were associated to delirium according to the logistic regression analysis. Conclusion: The frequency of delirium and hypoactivity was high. It is therefore necessary to routinely evaluate patients with standardized instruments. All patients presented with important neurocognitive alterations. Several factors related with the physiopathology of delirium were associated to the diagnosis; some of them are modifiable through the rationalization of medical care

Clinical characteristics, prevalence, and factors related to delirium in children of 5 to 14 years of age admitted to intensive care. / Características clínicas, prevalencia y factores asociados al delirium en niños de 5 a 14 años de edad ingresados en cuidados intensivos.

OBJECTIVE: To evaluate the clinical characteristics, prevalence and factors associated with delirium in critical patients from 5 to 14 years of age. DESIGN: An analytical, cross-sectional observational study was made. Delirium was assessed with the Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) and motor classification was established with the Delirium Rating Scale Revised-98. SETTING: A pediatric Intensive Care Unit. PATIENTS: All those admitted over a one-year period were assessed during the first 24-72h, or when possible in deeply sedated patients. EXCLUSION CRITERIA: Patients in stupor or coma, with severe communication difficulty, subjected to deep sedation throughout admission, and those with denied consent. RESULTS: Twenty-nine of the 156 assessed patients suffered delirium (18.6%) and 55.2% were hypoactive. The neurocognitive alterations evaluated by the pCAM-ICU were similar in the three motor groups. Intellectual disability (OR=17.54; 95%CI: 3.23-95.19), mechanical ventilation (OR=18.80; 95%CI: 4.29-82.28), liver failure (OR=54.88; 95%CI: 4.27-705.33), neurological disease (OR=4.41; 95%CI: 1.23-15.83), anticholinergic drug use (OR=3.23; 95%CI: 1.02-10.26), different psychotropic agents (OR=4.88; 95%CI: 1.42-16.73) and tachycardia (OR=4.74; 95%CI: 1.21-18.51) were associated to delirium according to the logistic regression analysis. CONCLUSION: The frequency of delirium and hypoactivity was high. It is therefore necessary to routinely evaluate patients with standardized instruments. All patients presented with important neurocognitive alterations. Several factors related with the physiopathology of delirium were associated to the diagnosis; some of them are modifiable through the rationalization of medical care.