Delirium in a Tertiary Pediatric Cardiac Intensive Care Unit: Risk Factors and Outcomes

2021 ◽  
pp. 088506662110668
Author(s):  
Andrew M. Koth ◽  
Titus Chan ◽  
Yuen Lie Tjoeng ◽  
R. Scott Watson ◽  
Leslie A. Dervan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Hospital Length Of Stay ◽  
Critically Ill Children ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Objective Delirium is an increasingly recognized hospital complication associated with poorer outcomes in critically ill children. We aimed to evaluate risk factors for screening positive for delirium in children admitted to a pediatric cardiac intensive care unit (CICU) and to examine the association between duration of positive screening and in-hospital outcomes. Study design Retrospective cohort study in a single-center quaternary pediatric hospital CICU evaluating children admitted from March 2014-October 2016 and screened for delirium using the Cornell Assessment of Pediatric Delirium. Statistical analysis used multivariable logistic and linear regression. Results Among 942 patients with screening data (98% of all admissions), 67% of patients screened positive for delirium. On univariate analysis, screening positive was associated with younger age, single ventricle anatomy, duration of mechanical ventilation, continuous renal replacement therapy, extracorporeal life support, and surgical complexity, as well as higher average total daily doses of benzodiazepines, opioids, and dexmedetomidine. On multivariable analysis, screening positive for delirium was independently associated with age <2 years, duration of mechanical ventilation, and greater than the median daily doses of benzodiazepine and opioid. In addition to these factors, duration of screening positive was also independently associated with higher STAT category (3-5) or medical admission, organ failure, acute kidney injury (AKI), and higher dexmedetomidine exposure. Duration of positive delirium screening was associated with both increased CICU and hospital length of stay (each additional day of positive screening was associated with a 3% longer CICU stay [95% CI = 1%-6%] and 2% longer hospital stay [95% CI = 0%-4%]). Conclusions Screening positive for delirium is common in the pediatric CICU and is independently associated with prolonged intensive care unit (ICU) and hospital stay. Longer duration of mechanical ventilation and higher sedative doses are independent risk factors for screening positive for delirium. Efforts aimed at reducing these exposures may decrease the burden of delirium in this population.

Do neonates, infants and young children need a higher dose of enoxaparin in the cardiac intensive care unit?

2010 ◽  
Vol 20 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Joan Sanchez de Toledo ◽  
Sriya Gunawardena ◽  
Ricardo Munoz ◽  
Richard Orr ◽  
Donald Berry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Young Children ◽  
Statistical Significance ◽  
Factor Xa ◽  
Retrospective Chart Review ◽  
Bleeding Complications ◽  
Critically Ill Children ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

AbstractBackgroundThromboembolic events are a serious complication occurring in critically ill children admitted to the cardiac intensive care unit. Although enoxaparin is one of the current anticoagulants of choice, dosages in children are extrapolated from adult guidelines. Recent data suggest that this population may need a higher dose than what is currently recommended to achieve target anti-factor Xa levels. The purpose of this study was to evaluate whether children less than 2 years old admitted to the cardiac intensive care unit require a higher enoxaparin dose than that currently recommended to achieve target anti-factor Xa levels.MethodsRetrospective chart review including patients who received enoxaparin for the treatment or prophylaxis of venous thrombosis between January, 2005 and October, 2007. Patients were classified as younger and older as well as prophylactic and therapeutic on the basis of age and enoxaparin dose, respectively. Younger patients were those 2 month old or less and older patients were those older than 2 months of age.ResultsA total of 31 patients were identified; 13 (42%) were 2 months or younger and 25 (81%) were postoperative patients. Ten (32%) received prophylactic and 21 (68%) received therapeutic enoxaparin doses. To achieve optimal anti-factor Xa levels, enoxaparin dose was increased in all groups and reached statistical significance in all patients except those older than 2 months who received prophylactic enoxaparin. An average of 2.8 dosage adjustments was needed. No bleeding complications were reported.ConclusionsYoung children, infants, and neonates admitted to the cardiac intensive care unit required a significantly higher enoxaparin dose than that currently recommended to achieve target anti-factor Xa levels.

scholarly journals Incidence of Delirium and Its Related Risk Factors Among Patients in Cardiac Intensive Care Unit

2021 ◽  
Vol 18 (2) ◽  
pp. 205-209
Author(s):  
Jalil Azimian ◽  
◽  
Mohammad Ali Soleimani ◽  
Seyed Saeed Farzam ◽  
Zahra Rahimi Dosaldeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Related Risk ◽  
Cardiac Intensive Care

scholarly journals Iatrogenic withdrawal syndrome in the pediatric cardiac intensive care unit: Incidence, risk factors and outcome

2021 ◽  
Vol 33 (4) ◽  
pp. 251-260
Author(s):  
Eiad Habib ◽  
Abdul Hakim Almakadma ◽  
Mohieddin Albarazi ◽  
Somiya Jaimon ◽  
Rayd Almehizia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Withdrawal Syndrome ◽  
Cardiac Intensive Care Unit ◽  
Incidence Risk ◽  
Cardiac Intensive Care ◽  
Iatrogenic Withdrawal Syndrome

scholarly journals Nursing management of anxiety and sleep disorders in patients hospitalized in a cardiac intensive care unit

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
K Mzoughi ◽  
S Mansouri ◽  
I Aissa ◽  
I Ben Mrad ◽  
I Zairi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sleep Disorders ◽  
Univariate Analysis ◽  
Vital Signs ◽  
Female Gender ◽  
High Rate ◽  
Poor Sleep ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac intensive care unit is an environment that induces a high rate of stress, anxiety and sleep disorders in hospitalized patients. All these elements can create an obstacle in the continuity of care and increase cardiovascular risk. Purpose The purpose of our study was to evaluate the anxiety and sleep disorders in patients admitted to the ICUU and to evaluate nurses’ behavior to these disorders. Materials and methods We conducted a descriptive, transversal, observational, prospective study in the cardiology department of Habib Thameur Hospital, which included 37 patients admitted to the ICU and 11 nurses practicing in the department. A questionnaire including two validated scales (HADS-A for anxiety and RCSQ for sleep) was submitted to patients and a self-questionnaire was administered to nurses. Results Patients mean age was 61.24 ± 13.41 years with a sex ratio of 2.36. Eight patients (22%) admitted to the ICU had anxiety disorder. In univariate analysis, female gender and mean hospital stay were significantly associated with anxiety among patients admitted to the ICU. In multivariate analysis, female gender was the only independent factor associated with anxiety at ICU hospitalization (relative risk = 3, 95% confidence interval 2.25-3.37, p = 0.005). Seventeen patients (40%) were afraid of death. The majority of patients (92%, n = 34) felt safe with the health care team. Most patients (92%, n = 34) responded to their visitors (through the window), 97% of whom were family members. Seven patients (19%) had poor sleep. The item with the lowest average was the quality of sleep (53.86 ± 15.65). In univariate analysis, urban living and the average number of sleep hours were significantly associated with poor sleep. Surveillance of vital signs, noise and monitor alarms were the main factors of sleep disturbance. Eleven nurses were included in our study. Seven nurses considered the management of anxiety as not important, and six answered that the management of sleep disorders was not important. The most used medication by nurses to relieve both symptoms was Hydroxyzine tablets. The most common non-medical way to relieve anxiety was privacy. The most common non-medication way to improve sleep was brightness reduction. Conclusion Our study shows that despite the prevalence of anxiety and sleep disorders in patients admitted to the ICU, their care by nurses was not adequate. Specific training on assessment and coping with these disorders could improve nursing care.

Risk Factors for Catheter-associated Bloodstream Infections in a Pediatric Cardiac Intensive Care Unit

2010 ◽  
Vol 29 (9) ◽  
pp. 812-815 ◽  
Author(s):  
Priya A. Prasad ◽  
Troy E. Dominguez ◽  
Theoklis E. Zaoutis ◽  
Samir S. Shah ◽  
Eva Teszner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

scholarly journals A Study of Acute Kidney Injury in a Tertiary Care Pediatric Intensive Care Unit

2020 ◽  
Author(s):  
Akanksha C. Parikh ◽  
Milind S. Tullu
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Hospital Stay ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children

AbstractThe objective of this study was to calculate the incidence, severity, and risk factors for acute kidney injury (AKI) in a tertiary care pediatric intensive care unit (PICU). Also, to assess the impact of AKI and its varying severity on mortality and length of hospital and PICU stays. A prospective observational study was performed in children between 1 month and 12 years of age admitted to the PICU between July 1, 2013, and July 31, 2014 (13 months). The change in creatinine clearance was considered to diagnose and stage AKI according to pediatric risk, injury, failure, loss, and end-stage renal disease criteria. The risk factors for AKI and its impact on PICU stay, hospital stay, and mortality were evaluated. Of the total 220 patients enrolled in the study, 161 (73.2%) developed AKI, and 59 cases without AKI served as the “no AKI” (control) group. Majority (57.1%) of children with AKI had Failure grade of AKI, whereas 26.1% had Risk grade and 16.8% had Injury grade of AKI. Infancy (p = 0.000), hypovolemia (p = 0.005), shock (p = 0.008), and sepsis (p = 0.022) were found to be significant risk factors for AKI. Mortality, PICU stay, and hospital stay were comparable in children with and without AKI as well as between the various grades of renal injury (i.e., Failure, Risk, and Injury). An exceedingly high incidence of AKI, especially of the severe Failure grade was observed in critically ill children. Infancy and frequent PICU occurrences such as sepsis, hypovolemia, and shock predisposed to AKI.

Risk Factors and Outcomes Associated With Readmission to the Intensive Care Unit After Cardiac Surgery

2016 ◽  
Vol 27 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Young Ae Kang
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Stay ◽  
Operation Time ◽  
Unplanned Readmission ◽  
High Blood Glucose ◽  
Icu Discharge

Unplanned readmission to the intensive care unit (ICU) is associated with poor prognosis, longer hospital stay, increased costs, and higher mortality rate. In this retrospective study, involving 1368 patients, the risk factors for and outcomes of ICU readmission after cardiac surgery were analyzed. The readmission rate was 5.9%, and the most common reason for readmission was cardiac issues. Preoperative risk factors were comorbid conditions, mechanical ventilation, and admission route. Perioperative risk factors were nonelective surgery, duration of cardiopulmonary bypass, and longer operation time. Postoperative risk factors were prolonged mechanical ventilation time, new-onset arrhythmia, unplanned reoperation, massive blood transfusion, prolonged inotropic infusions, and complications. Other factors were high blood glucose level, hemoglobin level, and score on the Acute Physiology and Chronic Health Evaluation II. In-hospital stay was longer and late mortality was higher in the readmitted group. These data could help clinical practitioners create improved ICU discharge protocols or treatment algorithms to reduce length of stay or to reduce readmissions.

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