Antipsychotic Treatment of Delirium in Critically Ill Children: A Retrospective Matched Cohort Study

OBJECTIVE To describe the use of pharmacologic treatment in critically ill children treated according to a delirium protocol and compare those treated with antipsychotics to those treated non-pharmacologically. METHODS The study included a retrospective matched cohort describing patients who were pharmacologically treated for delirium compared to those with delirium but not treated in a PICU from December 2013 to September 2015, using a delirium management protocol. Patients were matched by age, sex, diagnosis, mechanical ventilation (MV), and presence of delirium. RESULTS Of 1875 patients screened, 188 (10.03%) were positive for delirium. Of those, 15 patients (8%) were treated with an antipsychotic for delirium. Patients with delirium treated with antipsychotics were younger, had more delirium days (6 vs. 3, p=0.022), longer MV days (14 vs. 7, p=0.017), and longer PICU length of stay (34 vs. 16 days, p=0.029) than in the untreated group. Haloperidol, risperidone, and quetiapine were used in 9, 6, and 2 patients, respectively. Two patients were treated with multiple antipsychotics. Antipsychotic treatment was initiated on day 2 of delirium for 8 of 15 patients (53.3%). Ten patients in the treatment group had improved delirium scores by day 2 of treatment. No significant differences in sedation exposure between groups. No significant adverse effects were reported. CONCLUSIONS No significant adverse events seen in this small cohort of critically ill pediatric patients with delirium treated with antipsychotic therapy. Patients with early-onset delirium refractory to non-pharmacologic treatment may have a more effective response to antipsychotic therapy than patients with late-onset refractory delirium.

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Effectiveness of a targeted temperature management protocol using a cooling blanket in critically ill children with acute brain injury

JOURNAL OF PEDIATRIC CRITICAL CARE ◽

10.21304/2018.0501.00291 ◽

2018 ◽

Vol 5 (7) ◽

pp. 84

Author(s):

Sajith Kesavan ◽

Ramachandran Bala ◽

Ravikumar Krupanandan

Keyword(s):

Brain Injury ◽

Critically Ill ◽

Acute Brain Injury ◽

Targeted Temperature Management ◽

Temperature Management ◽

Critically Ill Children ◽

Management Protocol

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Probiotics in critically ill children

F1000Research ◽

10.12688/f1000research.7630.1 ◽

2016 ◽

Vol 5 ◽

pp. 407 ◽

Cited By ~ 15

Author(s):

Sunit C. Singhi ◽

Suresh Kumar

Keyword(s):

Critically Ill ◽

Lactobacillus Reuteri ◽

Very Low Birth Weight ◽

Late Onset ◽

Mucosal Barrier ◽

Critically Ill Children ◽

Gut Microflora ◽

Low Birth Weight Infants ◽

Single Strain ◽

Prevention And Treatment

Gut microflora contribute greatly to immune and nutritive functions and act as a physical barrier against pathogenic organisms across the gut mucosa. Critical illness disrupts the balance between host and gut microflora, facilitating colonization, overgrowth, and translocation of pathogens and microbial products across intestinal mucosal barrier and causing systemic inflammatory response syndrome and sepsis. Commonly used probiotics, which have been developed from organisms that form gut microbiota, singly or in combination, can restore gut microflora and offer the benefits similar to those offered by normal gut flora, namely immune enhancement, improved barrier function of the gastrointestinal tract (GIT), and prevention of bacterial translocation. Enteral supplementation of probiotic strains containing either Lactobacillus alone or in combination with Bifidobacterium reduced the incidence and severity of necrotizing enterocolitis and all-cause mortality in preterm infants. Orally administered Lactobacillus casei subspecies rhamnosus, Lactobacillus reuteri, and Lactobacillus rhamnosus were effective in the prevention of late-onset sepsis and GIT colonization by Candida in preterm very low birth weight infants. In critically ill children, probiotics are effective in the prevention and treatment of antibiotic-associated diarrhea. Oral administration of a mix of probiotics for 1 week to children on broad-spectrum antibiotics in a pediatric intensive care unit decreased GIT colonization by Candida, led to a 50% reduction in candiduria, and showed a trend toward decreased incidence of candidemia. However, routine use of probiotics cannot be supported on the basis of current scientific evidence. Safety of probiotics is also a concern; rarely, probiotics may cause bacteremia, fungemia, and sepsis in immunocompromised critically ill children. More studies are needed to answer questions on the effectiveness of a mix versus single-strain probiotics, optimum dosage regimens and duration of treatment, cost effectiveness, and risk-benefit potential for the prevention and treatment of various critical illnesses.

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Variations in analgesic, sedation, and delirium management between trauma and non-trauma critically ill children

Pediatric Surgery International ◽

10.1007/s00383-021-05039-1 ◽

2021 ◽

Author(s):

Steven C. Mehl ◽

Megan E. Cunningham ◽

Michael D. Chance ◽

Huirong Zhu ◽

Sara C. Fallon ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Children ◽

Delirium Management

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Glutamine Randomized Studies in Early Life: The Unsolved Riddle of Experimental and Clinical Studies

Clinical and Developmental Immunology ◽

10.1155/2012/749189 ◽

2012 ◽

Vol 2012 ◽

pp. 1-17 ◽

Cited By ~ 21

Author(s):

Efrossini Briassouli ◽

George Briassoulis

Keyword(s):

Critical Illness ◽

Critically Ill ◽

Early Life ◽

Late Onset ◽

Controlled Trial ◽

Glutamine Supplementation ◽

Critically Ill Children ◽

Randomized Studies ◽

Late Onset Sepsis ◽

Shock Proteins

Glutamine may have benefits during immaturity or critical illness in early life but its effects on outcome end hardpoints are controversial. Our aim was to review randomized studies on glutamine supplementation in pups, infants, and children examining whether glutamine affects outcome. Experimental work has proposed various mechanisms of glutamine action but none of the randomized studies in early life showed any effect on mortality and only a few showed some effect on inflammatory response, organ function, and a trend for infection control. Although apparently safe in animal models (pups), premature infants, and critically ill children, glutamine supplementation does not reduce mortality or late onset sepsis, and its routine use cannot be recommended in these sensitive populations. Large prospectively stratified trials are needed to better define the crucial interrelations of “glutamine-heat shock proteins-stress response” in critical illness and to identify the specific subgroups of premature neonates and critically ill infants or children who may have a greater need for glutamine and who may eventually benefit from its supplementation. The methodological problems noted in the reviewed randomized experimental and clinical trials should be seriously considered in any future well-designed large blinded randomized controlled trial involving glutamine supplementation in critical illness.

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