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 ◽  
...  
2021 ◽  
Vol 18 (2) ◽  
pp. 205-209
Author(s):  
Jalil Azimian ◽  
◽  
Mohammad Ali Soleimani ◽  
Seyed Saeed Farzam ◽  
Zahra Rahimi Dosaldeh ◽  
...  

2010 ◽  
Vol 29 (9) ◽  
pp. 812-815 ◽  
Author(s):  
Priya A. Prasad ◽  
Troy E. Dominguez ◽  
Theoklis E. Zaoutis ◽  
Samir S. Shah ◽  
Eva Teszner ◽  
...  

2021 ◽  
pp. 36-39
Author(s):  
Rohan Ainchwar ◽  
Harshawardhan Dhanraj Ramteke ◽  
Saniya Sheikh

Introduction: Many Patients admitted to Cardiac ICU (CICU) are easily prone to Delirium, that can lead to potentially severe consequences like Cognitive Impairment and increased risks of mortality. Delirium depends on the duration of hospital stay and discharge, contrary mainly affected to the patients on mechanical ventilation, which becomes the potential reason for longer duration. Studies suggest, Delirium is a widely discussed topic, when comes to the management of the patient in Cardiac ICU. During the Rounds, it is mandatory to focus on the diagnosis of delirium and must be validated using Confusion Assessment Method (CAM). These methods not only prevent the risk of the delirium and also enhances the use of the other preventive measures like the basis of the treatment, environmental factors, quiet time, sleep promotion, family support, communication with the patient, pain and dyspnea. When conrmed with delirium, pharmacological prophylaxis must be used as soon as possible. Most often, communication between Doctor, Nurse and Patient drives the most of the depression and acute delirium, but when delirium becomes critical with severe agitation or weaning from invasive mechanical ventilation. Thus, it is very important to identify the risk, complexity of the patients and clinical case scenarios of delirium in Cardiac ICU. Strategic Efforts were done to improve the identication of the patient at risk during admission, during stay at Cardiac ICU and during discharge and orders to improve the mental state of delirium patient. In this article, we provide a panorama of the incidence, risk factors, and impact on outcome of delirium in a Cardiac Intensive Care Unit (CICU). Methods: In this case study, total of 211 patients were observed for sign and symptoms in Cardiac ICU for Delirium. We aimed to determine the incidence, risk factors, and impact on outcome of delirium in a Cardiac Intensive Care Unit (CICU) in CHLMultispeciality Hospital and Research Center, Chandrapur using a prospective observational study. Patients:All consecutive patients admitted to the CICU between April 2021 and June 2021 were included if they were aged more than 18 years, had an CICU stay of more than 24 h and no psychiatric history. Patients eligible for the study were evaluated by the medical staff to detect delirium using the CAM. Results: In a 3-month period, 211 Patients were admitted in Cardiac ICU of CHLMultispeciality Hospital and Research Center. Out of which 198 were included in our observational study. The incidence of delirium at the end of the study was 21%. The number of delirious patients were 43 and non-delirious were 155. Age played an Important factor where 86% of Delirious patients were old aged. The LOS (Length of Stay) for Delirious and non-delirious patients were 6±1 vs 5±1 respectively. The SAS (Riker Agitation Scale) has the value of 4±1 vs 3±0.5, CAM (Confusion Assessment Method) has the value of 6±1 vs 3±1 and DDS (Delirium Detection Score) was 5±1 vs 3±1 for delirious vs non-delirious patients. The SAPS II (Simplied Acute Physiology Score II) Score for delirious patients was 23±1 and 20±2. The Incidences like Removal of Catheters were more frequent in this study with 20% in delirious patients and <1% Incidence in non-delirious patients. Removal of ET Tube had the Incidence of 5% vs <1%, Removal of Urinary Catheter 7% vs <1%, Removal of Ryle's Tube 7% vs <1%, respectively for delirious vs non-delirious patients.


2021 ◽  
pp. 088506662110668
Author(s):  
Andrew M. Koth ◽  
Titus Chan ◽  
Yuen Lie Tjoeng ◽  
R. Scott Watson ◽  
Leslie A. Dervan

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.


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