Delirium in children – new research directions
DOI:
https://doi.org/10.20883/medical.e478Keywords:
delirium, pediatric delirium, children, biomarkers, PK/PD modelingAbstract
One of the problems associated with a patient's stay in the hospital and the procedures they undergo is delirium, the occurrence of which is associated with numerous complications, longer stay in the ward, higher risk of death and increased healthcare costs. Scientists are continuing to search for effective methods to minimise the risk of its occurrence, as well as to develop effective therapeutic procedures. One such area of the research is the identification of delirium biomarkers, which would allow further PK/PD (pharmacokinetic/pharmacodynamic) modelling. This article focuses on the emergence delirium, which occurs in patients recovering from general anaesthesia.
Downloads
References
Appendix I, DSM-IV and scales for measuring delirium. National Clinical Guideline Centre (UK). Delirium: Diagnosis, Prevention and Management. https://www.ncbi.nlm.nih.gov/books/NBK65545
Whitlock E, Vannucci A, Avidan M. Postoperative delirium. Minerva Anestesiol. 2011;77(4):448-56. PMID 21483389
Silver GH, Kearney JA, Bora S, De Souza C, Giles L, Hrycko S, Jenkins W, Malas N, Namerow L, Ortiz-Aguayo R, Russell R, Pao M, Plioplys S, Brahmbhatt K, . A Clinical Pathway to Standardize Care of Children With Delirium in Pediatric Inpatient Settings. Hospital Pediatrics. 2019 Oct 29;9(11):909-916. https://doi.org/10.1542/hpeds.2019-0115
Nellis ME, Goel R, Feinstein S, Shahbaz S, Kaur S, Traube C. Association Between Transfusion of RBCs and Subsequent Development of Delirium in Critically Ill Children*. Pediatric Critical Care Medicine. 2018 Oct;19(10):925-929. https://doi.org/10.1097/pcc.0000000000001675
Meyburg J, Dill M, Traube C, Silver G, von Haken R. Patterns of Postoperative Delirium in Children*. Pediatric Critical Care Medicine. 2017 Feb;18(2):128-133. https://doi.org/10.1097/pcc.0000000000000993
Kawai Y, Weatherhead JR, Traube C, Owens TA, Shaw BE, Fraser EJ, Scott AM, Wojczynski MR, Slaman KL, Cassidy PM, Baker LA, Shellhaas RA, Dahmer MK, Shever LL, Malas NM, Niedner MF. Quality Improvement Initiative to Reduce Pediatric Intensive Care Unit Noise Pollution With the Use of a Pediatric Delirium Bundle. Journal of Intensive Care Medicine. 2017 Sep 1;34(5):383-390. https://doi.org/10.1177/0885066617728030
Kain ZN. Preoperative Anxiety in Children. Archives of Pediatrics & Adolescent Medicine. 1996 Dec 1;150(12):1238. https://doi.org/10.1001/archpedi.1996.02170370016002
Gunther ML, Morandi A, Ely EW. Pathophysiology of Delirium in the Intensive Care Unit. Critical Care Clinics. 2008 Jan;24(1):45-65. https://doi.org/10.1016/j.ccc.2007.10.002
Maldonado JR. Delirium in the Acute Care Setting: Characteristics, Diagnosis and Treatment. Critical Care Clinics. 2008 Oct;24(4):657-722. https://doi.org/10.1016/j.ccc.2008.05.008
Gaudreau J, Gagnon P, Roy M, Harel F, Tremblay A. Association Between Psychoactive Medications and Delirium in Hospitalized Patients: A Critical Review. Psychosomatics. 2005 Jul;46(4):302-316. https://doi.org/10.1176/appi.psy.46.4.302
Han L, McCusker J, Cole M, Abrahamowicz M, Primeau F, Élie M. Use of Medications With Anticholinergic Effect Predicts Clinical Severity of Delirium Symptoms in Older Medical Inpatients. Archives of Internal Medicine. 2001 Apr 23;161(8):1099. https://doi.org/10.1001/archinte.161.8.1099
Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, Hanly PJ. Contribution of the Intensive Care Unit Environment to Sleep Disruption in Mechanically Ventilated Patients and Healthy Subjects. American Journal of Respiratory and Critical Care Medicine. 2003 Mar;167(5):708-715. https://doi.org/10.1164/rccm.2201090
Engel GL, Romano J. Delirium, A Syndrome of Cerebral Insufficiency. The Journal of Neuropsychiatry and Clinical Neurosciences. 2004 Nov;16(4):526-538. https://doi.org/10.1176/jnp.16.4.526
Stollings JL, Thompson JL, Ferrell BA, Scheinin M, Wilkinson GR, Hughes CG, Shintani AK, Ely EW, Girard TD, Pandharipande PP, Patel MB. Sedative Plasma Concentrations and Delirium Risk in Critical Illness. Annals of Pharmacotherapy. 2018 Jan 24;52(6):513-521. https://doi.org/10.1177/1060028017753480
Pandharipande P, Girard T, Jackson J, Morandi A, Thompson J, Pun B, Brummel N, Hughes C, Vasilevskis E, Shintani A, Moons K, Geevarghese S, Canonico A, Hopkins R, Bernard G, Dittus R, Ely E. Long-Term Cognitive Impairment after Critical Illness. New England Journal of Medicine. 2013 Oct 3;369(14):1306-1316. https://doi.org/10.1056/nejmoa1301372
Bolton C, Thilges S, Lane C, Lowe J, Mumby P. Post-traumatic Stress Disorder Following Acute Delirium. Journal of Clinical Psychology in Medical Settings. 2019 Dec 10;. https://doi.org/10.1007/s10880-019-09689-1
Colville G, Kerry S, Pierce C. Children's Factual and Delusional Memories of Intensive Care. American Journal of Respiratory and Critical Care Medicine. 2008 May;177(9):976-982. https://doi.org/10.1164/rccm.200706-857oc
Marcantonio ER, Rudolph JL, Culley D, Crosby G, Alsop D, Inouye SK. Review Article: Serum Biomarkers for Delirium. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2006 Dec 1;61(12):1281-1286. https://doi.org/10.1093/gerona/61.12.1281
Trogrlić Z, Ista E, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Dijkstra A, Bakker J, van der Jagt M. Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals. Nursing in Critical Care. 2016 Mar 20;22(3):133-140. https://doi.org/10.1111/nicc.12239
Rotter T, Kinsman L, James EL, Machotta A, Gothe H, Willis J, Snow P, Kugler J. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. . Cochrane Database of Systematic Reviews. 2010 Mar 17;. https://doi.org/10.1002/14651858.cd006632.pub2
Brahmbhatt K, Whitgob E. Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review. Pediatrics. 2016 Feb 2;137(3):e20151940. https://doi.org/10.1542/peds.2015-1940
Schieveld JNM, Leroy PLJM, van Os J, Nicolai J, Vos GD, Leentjens AFG. Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit. Intensive Care Medicine. 2007 Apr 25;33(6):1033-1040. https://doi.org/10.1007/s00134-007-0637-8
Mason K. Paediatric emergence delirium: a comprehensive review and interpretation of the literature. British Journal of Anaesthesia. 2017 Mar;118(3):335-343. https://doi.org/10.1093/bja/aew477
Silver G, Traube C, Gerber LM, Sun X, Kearney J, Patel A, Greenwald B. Pediatric Delirium and Associated Risk Factors. Pediatric Critical Care Medicine. 2015 May;16(4):303-309. https://doi.org/10.1097/pcc.0000000000000356
Hatherill S, Flisher AJ. Delirium in children and adolescents: A systematic review of the literature. Journal of Psychosomatic Research. 2010 Apr;68(4):337-344. https://doi.org/10.1016/j.jpsychores.2009.10.011
Mason K. Paediatric emergence delirium: a comprehensive review and interpretation of the literature. British Journal of Anaesthesia. 2017 Mar;118(3):335-343. https://doi.org/10.1093/bja/aew477
Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, Halpert S, Augenstein J, Sickles LE, Li C, Greenwald B. Cornell Assessment of Pediatric Delirium. Critical Care Medicine. 2014 Mar;42(3):656-663. https://doi.org/10.1097/ccm.0b013e3182a66b76
Menser C, Smith H. Emergence Agitation and Delirium: Considerations for Epidemiology and Routine Monitoring in Pediatric Patients. Local and Regional Anesthesia. 2020 Jul;13:73-83. https://doi.org/10.2147/lra.s181459
Bajwa SA, Costi D, Cyna AM. A comparison of emergence delirium scales following general anesthesia in children. Pediatric Anesthesia. 2010 May 20;20(8):704-711. https://doi.org/10.1111/j.1460-9592.2010.03328.x
LaHue SC, James TC, Newman JC, Esmaili AM, Ormseth CH, Ely EW. Collaborative Delirium Prevention in the Age of COVID‐19. Journal of the American Geriatrics Society. 2020 May;68(5):947-949. https://doi.org/10.1111/jgs.16480
West N, Christopher N, Stratton K, Görges M, Brown Z. Reducing preoperative anxiety with Child Life preparation prior to intravenous induction of anesthesia: A randomized controlled trial. Pediatric Anesthesia. 2020 Jan 8;30(2):168-180. https://doi.org/10.1111/pan.13802
Dwairej DA, Obeidat HM, Aloweidi AS. Video game distraction and anesthesia mask practice reduces children's preoperative anxiety: A randomized clinical trial. Journal for Specialists in Pediatric Nursing. 2019 Oct;25(1). https://doi.org/10.1111/jspn.12272
Faria RDSB, Moreno RP. Delirium in intensive care: an under-diagnosed reality. Revista Brasileira de Terapia Intensiva. 2013;25(2):137-147. https://doi.org/10.5935/0103-507x.20130025
Joyce C, Witcher R, Herrup E, Kaur S, Mendez-Rico E, Silver G, Greenwald BM, Traube C. Evaluation of the Safety of Quetiapine in Treating Delirium in Critically Ill Children: A Retrospective Review. Journal of Child and Adolescent Psychopharmacology. 2015 Nov;25(9):666-670. https://doi.org/10.1089/cap.2015.0093
Cunningham ME, Vogel AM. Analgesia, sedation, and delirium in pediatric surgical critical care. Seminars in Pediatric Surgery. 2019 Feb;28(1):33-42. https://doi.org/10.1053/j.sempedsurg.2019.01.006
Schieveld JNM, Leroy PLJM, van Os J, Nicolai J, Vos GD, Leentjens AFG. Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit. Intensive Care Medicine. 2007 Apr 25;33(6):1033-1040. https://doi.org/10.1007/s00134-007-0637-8
Population Pharmacokinetics. Guidance for Industry. https://www.fda.gov/media/128793/download
Toft K, Tontsch J, Abdelhamid S, Steiner L, Siegemund M, Hollinger A. Serum biomarkers of delirium in the elderly: a narrative review. Annals of Intensive Care. 2019 Jul 1;9(1). https://doi.org/10.1186/s13613-019-0548-1
Liu X, Yu Y, Zhu S. Inflammatory markers in postoperative delirium (POD) and cognitive dysfunction (POCD): A meta-analysis of observational studies. Ma D. PLOS ONE. 2018 Apr 11;13(4):e0195659. https://doi.org/10.1371/journal.pone.0195659
Kazmierski J, Banys A, Latek J, Bourke J, Jaszewski R. Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study. Critical Care. 2013;17(2):R38. https://doi.org/10.1186/cc12548
Khan BA, Zawahiri M, Campbell NL, Boustani MA. Biomarkers for Delirium-A Review. Journal of the American Geriatrics Society. 2011 Nov;59:S256-S261. https://doi.org/10.1111/j.1532-5415.2011.03702.x
Marcantonio ER, Rudolph JL, Culley D, Crosby G, Alsop D, Inouye SK. Review Article: Serum Biomarkers for Delirium. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2006 Dec 1;61(12):1281-1286. https://doi.org/10.1093/gerona/61.12.1281
Kotfis K, Bott-Olejnik M, Szylińska A, Rotter I. Could Neutrophil-to-Lymphocyte Ratio (NLR) Serve as a Potential Marker for Delirium Prediction in Patients with Acute Ischemic Stroke? A Prospective Observational Study. Journal of Clinical Medicine. 2019 Jul 22;8(7):1075. https://doi.org/10.3390/jcm8071075
Amgarth-Duff I, Hosie A, Caplan G, Agar M. A systematic review of the overlap of fluid biomarkers in delirium and advanced cancer-related syndromes. BMC Psychiatry. 2020 Apr 22;20(1). https://doi.org/10.1186/s12888-020-02584-2
Kozak HH, Uğuz F, Kılınç İ, Uca AU, Serhat Tokgöz O, Akpınar Z, Özer N. Delirium in patients with acute ischemic stroke admitted to the non-intensive stroke unit: Incidence and association between clinical features and inflammatory markers. Neurologia i Neurochirurgia Polska. 2017 Jan;51(1):38-44. https://doi.org/10.1016/j.pjnns.2016.10.004
Vasunilashorn SM, Dillon ST, Inouye SK, Ngo LH, Fong TG, Jones RN, Travison TG, Schmitt EM, Alsop DC, Freedman SD, Arnold SE, Metzger ED, Libermann TA, Marcantonio ER. High C-Reactive Protein Predicts Delirium Incidence, Duration, and Feature Severity After Major Noncardiac Surgery. Journal of the American Geriatrics Society. 2017 May 26;65(8):e109-e116. https://doi.org/10.1111/jgs.14913
Dillon ST, Vasunilashorn SM, Ngo L, Otu HH, Inouye SK, Jones RN, Alsop DC, Kuchel GA, Metzger ED, Arnold SE, Marcantonio ER, Libermann TA. Higher C-Reactive Protein Levels Predict Postoperative Delirium in Older Patients Undergoing Major Elective Surgery: A Longitudinal Nested Case-Control Study. Biological Psychiatry. 2017 Jan;81(2):145-153. https://doi.org/10.1016/j.biopsych.2016.03.2098
Stasevic-Karlicic I, Stasevic M, Jankovic S, Djukic-Dejanovic S, Milovanovic S. Markers of inflammation as risk predictors of lethal outcome in patients diagnosed with delirium. Vojnosanitetski pregled. 2016;73(9):838-843. https://doi.org/10.2298/vsp141212012s
Neerland BE, Hall RJ, Seljeflot I, Frihagen F, MacLullich AMJ, Raeder J, Wyller TB, Watne LO. Associations Between Delirium and Preoperative Cerebrospinal Fluid C-Reactive Protein, Interleukin-6, and Interleukin-6 Receptor in Individuals with Acute Hip Fracture. Journal of the American Geriatrics Society. 2016 Jun 24;64(7):1456-1463. https://doi.org/10.1111/jgs.14238
Dąbrowska AM, Słotwiński R. The immune response to surgery and infection. Central European Journal of Immunology. 2014;4:532-537. https://doi.org/10.5114/ceji.2014.47741
Khan BA, Zawahiri M, Campbell NL, Boustani MA. Biomarkers for Delirium-A Review. Journal of the American Geriatrics Society. 2011 Nov;59:S256-S261. https://doi.org/10.1111/j.1532-5415.2011.03702.x
Population pharmacokinetics. https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-role-pharmacokinetics-development-medicinal-products-paediatric-population_en.pdf
https://www.fda.gov/media/128793/download
Cook SF, Bies RR. Disease Progression Modeling: Key Concepts and Recent Developments. Current Pharmacology Reports. 2016 Aug 15;2(5):221-230. https://doi.org/10.1007/s40495-016-0066-x
Downloads
Published
Issue
Section
License
Copyright (c) 2021 The copyright to the submitted manuscript is held by the Author, who grants the Journal of Medical Science (JMS) a nonexclusive licence to use, reproduce, and distribute the work, including for commercial purposes.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Accepted 2020-12-29
Published 2021-02-24
