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Two months outcomes following delirium in the pediatric intensive care unit

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Abstract

The lasting consequences of delirium in children are not well characterized. This study aimed to compare the two-month outcomes in pediatric intensive care unit (PICU) survivors according to the presence of delirium. Post-hoc analysis of a single-center prospective study of mechanically ventilated (invasive ventilation or non-invasive ventilation) children followed at the CHU Sainte-Justine PICU follow-up clinic two months after PICU discharge, between October 2018 and August 2022. Delirium was defined as one or more Cornell Assessment of Pediatric Delirium (CAPD) scores ≥ 9. Primary outcome was survivors’ quality of life and secondary outcomes were sleep and posttraumatic stress and anxiety and depression in parents. Multivariable linear and logistic regression models assessed the independent associations between delirium and outcomes while adjusting for age, sex, comorbidity, diagnosis, severity of illness, PICU length of stay, and invasive mechanical ventilation. Of the 179 children included over a 47 month-period, 117 (65.4%) had delirium. Children with delirium were more commonly intubated (91.5% vs. 30.7%, p < 0.001) and had higher PELOD-2 scores (10 vs. 4, p < 0.001). On multivariable analysis, delirium was associated with a decreased quality of life at 2.3 months post discharge (p = 0.03). The severity of the delirium episode (higher scores of CAPD) was associated with a higher likelihood of sleep disturbances (OR 1.13, p = 0.01) and parental anxiety (OR 1.16, p = 0.01), in addition to lower quality of life (p = 0.03).

Conclusions: Two months following their PICU stay, children with delirium had a lower quality of life, suggesting a lasting effect of delirium on children and their families.

What is Known:

•Delirium affects a third of critically ill children admitted to the Pediatric Intensive Care Unit (PICU).

•Delirium is associated with a decreased quality of life post-PICU stay.

What is New:

•This study is the first to investigate the lasting impact of delirium on diverse aspects of children’s well-being following a PICU stay.

•The severity of the delirium episode, assessed using the maximum CAPD score recorded, was associated with a higher likelihood of sleep disturbances, lower quality of life, and increased parental anxiety.

•A longer duration of delirium (in days) was associated with more sleep disturbances.

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

CAPD:

Cornell Assessment of Pediatric Delirium

CPC:

Child PTSD Checklist

HADS:

Hospital Anxiety and Depression Scale

IQR:

Interquartile ranges

PELOD-2:

Pediatric Logistic Organ Dysfunction

PICU:

Pediatric Intensive Care Unit

PTSD:

Post-traumatic stress disorder

QOL:

Quality of life

YCPC:

Young Child PTSD Checklist

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Funding

Supported by the CHU Sainte-Justine Research center.

Author information

Authors and Affiliations

  1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada

    Celine Thibault, Geneviève Du Pont-Thibodeau, Simon MacDonald, Camille Jutras, Marie-Élaine Metras, Karen Harrington, Baruch Toledano, Nadia Roumeliotis, Catherine Farrell, Jacques Lacroix & Laurence Ducharme-Crevier

  2. Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada

    Marie-Élaine Metras

Authors
  1. Celine Thibault
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  2. Geneviève Du Pont-Thibodeau
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  3. Simon MacDonald
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  4. Camille Jutras
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  10. Jacques Lacroix
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  11. Laurence Ducharme-Crevier
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Contributions

CT, GDPT and LDC wrote the main manuscript. All authors contributed to data aquisition. CT and LDC did the analysis and prepared the tables. All authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Laurence Ducharme-Crevier.

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Ethical approval

The Institutional Review Board of the CHU Sainte-Justine approved this study (2019–2261).

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter.

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Thibault, C., Pont-Thibodeau, G.D., MacDonald, S. et al. Two months outcomes following delirium in the pediatric intensive care unit. Eur J Pediatr (2024). https://doi.org/10.1007/s00431-024-05491-w

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  • DOI: https://doi.org/10.1007/s00431-024-05491-w

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