scholarly journals Antipsychotic Use in the Prevention and Treatment of Intensive Care Unit Delirium in Pediatric Patients

2020 ◽  
Vol 25 (2) ◽  
pp. 81-95
Author(s):  
Amanda C. Capino ◽  
Amber N. Thomas ◽  
Samantha Baylor ◽  
Kaitlin M. Hughes ◽  
Jamie L. Miller ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Qt Interval ◽  
Dosage Regimen ◽  
Pediatric Patients ◽  
Screening Tool ◽  
Drug Event ◽  
Future Research ◽  
Hospitalized Children ◽  
Prevention And Treatment ◽  
Intensive Care Unit Delirium

OBJECTIVES To describe the antipsychotics, route of administration, dosage regimen, and outcomes reported to prevent or treat delirium in hospitalized children. METHODS Medline, Embase, and International Pharmaceutical Abstracts were searched using the keywords “haloperidol,” “olanzapine,” “quetiapine,” “risperidone,” “ziprasidone,” and “delirium.” Articles evaluating the use of these agents to manage delirium in hospitalized children that were published between 1946 and August 2019 were included. Two authors independently screened each article for inclusion. Reports were excluded if they were published abstracts or included fewer than 3 patients in the report. RESULTS Thirteen reports that included 370 children receiving haloperidol, quetiapine, olanzapine, and/or risperidone for delirium treatment were reviewed. Most children received haloperidol (n = 131) or olanzapine (n = 125). Significant variability in dosing was noted. A total of 23 patients (6.2%) had an adverse drug event, including 13 (56.5%) who experienced dystonia and 3 (13.0%) with a prolonged corrected QT interval. Most reports described improvement in delirium symptoms; however, only 5 reports used a validated screening tool for PICU delirium to evaluate antipsychotic response. CONCLUSIONS Most reports noted efficacy with antipsychotics, but these reports were limited by sample size and lacked a validated PICU delirium tool. Future research is needed to determine the optimal agent and dosage regimen to treat PICU delirium.

scholarly journals Intensive Care Unit Delirium

2016 ◽  
Vol 125 (6) ◽  
pp. 1229-1241 ◽  
Author(s):  
Christina J. Hayhurst ◽  
Pratik P. Pandharipande ◽  
Christopher G. Hughes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prevention And Treatment ◽  
Intensive Care Unit Delirium

This review examines the most recent evidence for the diagnosis, prevention, and treatment of delirium in the ICU.

A Review of Nutritional Screening Tools for Hospitalized Children

2020 ◽  
Vol 16 (7) ◽  
pp. 1005-1014
Author(s):  
Meryem E. Öztürk ◽  
Nurcan Y. Ayhan
Keyword(s):  
Intensive Care Unit ◽  
Screening Tool ◽  
Hospital Costs ◽  
Age Groups ◽  
Screening Tools ◽  
Growth Charts ◽  
Hospitalized Children ◽  
Nutritional Screening ◽  
Severe Morbidity ◽  
Duration Of Hospitalization

Malnutrition is highly prevalent in hospitalized children and it is associated with severe morbidity and mortality outcomes. In addition malnutrition increases duration of hospitalization and hospital costs. Because of these reasons, so as to prevent the malnutrition several nutritional screening tools have been developed for hospitalized children in the last years. There are nine screening tools available in the literature. The screening tools should be valid and reliable. Beside this it is important that screening tools should be simple and take less time. Currently, there is no standardized nutritional screening tool for pediatric inpatients like adult inpatients. Tools should be revised and reevaluated with using anthropometric measurements, according to WHO growth charts. Besides, the accuracy of screening tools may improve if screening tools are standardized for certain diseases (cancer, kidney failure etc.), certain states (intensive care unit patients) or age groups.

scholarly journals Evaluation of QTc Interval Effects of Antipsychotic Medications for Intensive Care Unit Delirium in Pediatric Patients

2021 ◽  
Vol 26 (1) ◽  
pp. 87-91
Author(s):  
Lisa M. Hutchins ◽  
Andrakeia Shipman ◽  
Kanecia O. Zimmerman ◽  
Travis S. Heath
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Patients ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Antipsychotic Medications ◽  
Qtc Interval Prolongation ◽  
Intensive Care Unit Delirium ◽  
Icu Delirium

OBJECTIVE Intensive care unit delirium is an increasingly recognized problem in pediatric patients. Controversy exists regarding the safety and efficacy of antipsychotic medications for this indication. The objective of this study was to determine the incidence of and risk factors for QTc interval prolongation in pediatric patients treated with antipsychotics for ICU delirium. METHODS Retrospective chart review of pediatric patients admitted to the pediatric ICU or pediatric cardiac ICU and diagnosed with ICU delirium between October 1, 2014, and October 31, 2015. Patients were included if they received at least 1 dose of an antipsychotic for the treatment of delirium after a positive screen using the Cornell Assessment of Pediatric Delirium scoring tool. RESULTS For the 26 patients included, the median change in QTc interval on treatment was −4 msecs. Two patients (8%) had QTc interval prolongation while on antipsychotic therapy. No risk factors were identified in these 2 patients that put them at increased risk for QTc interval prolongation. CONCLUSIONS The incidence of QTc interval prolongation in pediatric patients who were treated with antipsychotics for ICU delirium was low. There is need for future research to determine which pediatric patients are at risk for QTc interval prolongation when antipsychotic medications are used for the treatment of ICU delirium.

An Updated Review on COVID-19

2020 ◽  
Vol 20 ◽  
Author(s):  
Mahmoud Ahmed Ebada ◽  
Ahmed Wadaa Allah ◽  
Eshak Bahbah ◽  
Ahmed Negida
Keyword(s):  
Screening Tool ◽  
Distress Syndrome ◽  
Reproduction Number ◽  
Case Fatality ◽  
Current Data ◽  
Future Research ◽  
Rt Pcr ◽  
Viral Structure ◽  
Discharge Criteria ◽  
Serology Testing

: Coronavirus Disease (COVID-19) pandemic has affected more than seven million individuals in 213 countries worldwide with a basic reproduction number ranging from 1.5 to 3.5 and an estimated case fatality rate ranging from 2% to 7%. A substantial proportion of COVID-19 patients are asymptomatic; however, symptomatic cases might present with fever, cough, and dyspnoea or severe symptoms up to acute respiratory distress syndrome. Currently, RNA RT-PCR is the screening tool, while bilateral chest CT is the confirmatory clinical diagnostic test. Several drugs have been repurposed to treat COVID-19, including chloroquine or hydroxychloroquine with or without azithromycin, lopinavir/ritonavir combination, remdesivir, favipiravir, tocilizumab, and EIDD-1931. Recently, Remdesivir gained FDA emergency approval based on promising early findings from the interim analysis of 1063 patients. The recently developed serology testing for SARSCoV-2 antibodies opened the door to evaluate the actual burden of the disease and to determine the rate of the population who have been previously infected (or developed immunity). This review article summarizes current data on the COVID-19 pandemic starting from the early outbreak, viral structure and origin, pathogenesis, diagnosis, treatment, discharge criteria, and future research.

Infanticide, Physicians, and the Law: The “Baby Doe” Amendments to the Child Abuse Prevention and Treatment Act

1985 ◽  
Vol 11 (1) ◽  
pp. 1-29
Author(s):  
Nelson Lund
Keyword(s):  
Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Medical Profession ◽  
Child Abuse Prevention ◽  
Western Civilization ◽  
Human Race ◽  
Medical Problems ◽  
Prevention And Treatment ◽  
Baby Doe ◽  
New Form

AbstractInfanticide, like most other species of homicide, is probably coeval with the human race itself. In modern Western civilization, what were formerly the most powerful incentives to infanticide have virtually disappeared. As with other social problems that affluence has seemed to solve, however, infanticide has reappeared in a new form that seems to have been made possible by affluence itself. This "new infanticide" occurs in a place whose very existence is the result of a tremendously wealthy society's devotion to its most vulnerable and least “useful” members. The modern neonatal intensive care unit, which treats, and often saves, extremely ill newborn children, who during most of history would surely have died, has proven to be a setting where many of the age-old incentives for infanticide have begun to operate again. The “new infanticide” consists of withholding food or needed medical treatment from selected infants who suffer from one or more serious, though treatable, medical problems. The national government has now enacted legislation designed to curtail the practice of infanticide by the medical profession. This paper traces the genesis of that legislation, explores the problem to which it is addressed, and evaluates its prospects for success.

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