scholarly journals Vitamin D levels in critically ill patients on admission and during the intensive care unit stay and its association with short and long-term morbidity and mortality: A single center observational study

Author(s):  
Kürşat Gündoğan
2020 ◽  
Author(s):  
Xiaohua Ge ◽  
Wanrui Wei ◽  
Qingru Zheng ◽  
Lili Xu ◽  
Yaqin Hu ◽  
...  

Abstract Objective: The primary objective of this study was to investigate the prevalence of intensive care unit (ICU) pediatric delirium in Shanghai, China. Secondary objectives were to determine the association of hypoxia and infection with ICU pediatric delirium, and the impact between different age. Design: Prospective single-center observational study. Setting: Two pediatric intensive care unit (PICU) within a tertiary-A general hospital. Patients: Patients age between 1 month to 7 years in PICU who stayed at least 1 day were included. Convenance sampling was used. Interventions: None. Measurements and Main Results: Pediatric patients (n=639) were screened twice a day for the prevalence of ICU pediatric delirium by Cornell Assessment of Pediatric Delirium, 300 (46.95%) of them had infection and 213 (33.33%) had hypoxia in PICU. Children who suffered hypoxia remained more than three times likely to be delirious during their hospitalization compared with children who were not hypoxia, after controlling other covariates, the odds of pediatric delirium for subjects with hypoxia was 3.26 times (95% CI, 1.98-5.38) the odds without hypoxia. Also, the odds of pediatric delirium for subjects with infection was 2.55 times (95% CI, 1.58-4.11) the odds without infection adjusting for other covariates. After subgrouping by age, the occurrence of ICU pediatric delirium with infection for children younger than two years old was 5.37 times (95% CI, 3.09-9.33) compared with patients who were never infection, while that for the children equal to or older than two years old was no statistically significant relationship. Conclusions: The prevalence of ICU pediatric delirium was 31.30%, while there is an independent association of infection and hypoxia with ICU pediatric delirium. Furthermore, children younger than two years old took more risks on pediatric delirium when they were infected in this study, while there was no relationship between infection and pediatric delirium who aged 2 years or older.


Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.


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