Purpose of Review
We describe preventative management, current screening tools, and treatment strategies for pediatric intensive care unit (PICU) delirium.
While there is ongoing research regarding medication efficacy for the treatment of delirium, there has been an increased emphasis on screening and prevention strategies.
PICU delirium is an underappreciated diagnosis that is associated with increased morbidity and increased length of stay. Strategies to minimize risk of delirium, early recognition of delirium, and mitigation strategies combined with education and engagement of both medical staff and families are of utmost importance. Identification of efficacious medications for the treatment of delirium is ongoing.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: diagnostic and statistical manual of mental disorders. Fifth ed. Arlington, VA: American Psychiatric Association; 2013.
Daoud A, Duff JP, Joffe AR. Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review. Crit Care. 2014;18:489. https://doi.org/10.1186/s13054-014-0489-x.
Cavallazzi R, Saad M, Marik PE: Delirium in the ICU: an overview. Ann Intensive Care. 2012, 2: 49–https://doi.org/10.1186/2110-5820-2-49.
Smith H, Gangopadhyay M, Goben C, et al. Delirium and benzodiazepines associated with prolonged ICU stay in critically ill infants and young children. Crit Care Med. 2017;45:1427–35. https://doi.org/10.1097/CCM.0000000000002515.
Brummel NE, Vasilevskis EE, Han JH, Boehm L, Pun BT, Ely EW. Implementing delirium screening in the ICU: secrets to success. Crit Care Med. 2013;41:2196–208. https://doi.org/10.1097/CCM.0b013e31829a6f1e.
Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med. 2014;370:444–54. https://doi.org/10.1056/NEJMra1208705.
Traube C, Silver G, Reeder RW, Doyle H, Hegel E, Wolfe HA, et al. Delirium in critically ill children: an international point prevalence study. Crit Care Med. 2017;45:584–90. https://doi.org/10.1097/CCM.0000000000002250
• Traube C, Silver G, Gerber LM, et al: Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med 2017; 45:891–898. https://doi.org/10.1097/CCM.0000000000002324. Epidemiologic analysis of pediatric-specific risk factors for development of delirium, subtype frequency, and fluctuation of symptoms.
• Dervan L, Di Gennaro J, Farris R, et al. (2020). Delirium in a tertiary PICU: risk factors and outcomes. Ped Crit care med, 2020:21:21-32. https://doi.org/10.1097/PCC.0000000000002126. Large study describing pediatric-specific risk factors for development of delirium and decline in PCPC at discharge.
Mody K, Kaur S, Mauer EA, Gerber LM, Greenwald BM, Silver G, et al. Benzodiazepines and development of delirium in critically ill children: estimating the causal effect. Crit Care Med. 2018;46:1486–91. https://doi.org/10.1097/CCM.0000000000003194.
Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004 May 1;100(5):1138–45. https://doi.org/10.1097/00000542-200405000-00015.
Smith H, Boyd J, Fuchs D, Melvin K, Berry P, Shintani A, et al. Diagnosing delirium in critically ill children: validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit*. Crit Care Med. 2011 Jan;39(1):150–7. https://doi.org/10.1097/CCM.0b013e3181feb489.
Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, et al. Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU. Crit Care Med. 2014 Mar;42(3):656–63. https://doi.org/10.1097/CCM.0b013e3182a66b76.
Valdivia HR, Carlin KE. Determining Interrater reliability of the Cornell Assessment of Pediatric Delirium screening tool among PICU nurses. Pediatr Crit Care Med. 2019;20(4):e216–20. https://doi.org/10.1097/PCC.0000000000001896.
Ista E, te Beest H, van Rosmalen J, de Hoog M, Tibboel D, van Beusekom B, et al. Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: a tool for early screening of delirium in the PICU. Australian Critical Care. 2018 Sep 1;31(5):266–73. https://doi.org/10.1016/j.aucc.2017.07.006.
Ista E, van Beusekom B, van Rosmalen J, Kneyber MCJ, Lemson J, Brouwers A, et al. Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study. Crit Care. 2018;22(1):309.
Ungarian J, Rankin, J, Then, K. Delirium in the intensive care unit: is dexmedetomidine effective? Critical Care Nurse, 2019;39:4: e8–e21. https://doi.org/10.4037/ccn2019591.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Critical Care.
About this article
Cite this article
Gu, S., Couloures, K. Pediatric Delirium: a Review of Current Diagnosis and Management in the Intensive Care Setting. Curr Pediatr Rep (2020). https://doi.org/10.1007/s40124-020-00222-9
- Non-pharmacologic interventions