Delirium and Cognitive Function Following Admission to the PICU . Critical Care Medicine. January 2018
Learning Objectives: Delirium is a well-defined complication of critical illness in adults and has been shown to be associated with long-term cognitive dysfunction. Pediatric critical care is now beginning to diagnose delirium, but its effect on cognitive function is unknown. The primary objective of this study was to investigate the incidence of delirium in the pediatric intensive care unit (PICU) and the relation to long-term cognitive dysfunction.
Methods: Children (5–17 years) with an anticipated PICU stay of > 24 hours without significant developmental delay or neurologic injury were recruited. Daily screens for delirium were conducted with the Cornell Assessment of Pediatric Delirium (CAPD) and Pediatric Confusion Assessment Method for the ICU (PCAM). The Children’s Memory Scale (CMS) was administered on all children at time of transfer from the PICU and 3 months later.
Results: Seventeen children completed the 3 month follow up: mean age = 12.1 years, 53% male, and 59% Latino. The mean PICU length of stay was 8.1 days (SD=11.6) and 59% were intubated. At time of transfer from the PICU 82% of the children were categorized as normal on the Pediatric Cerebral Performance Category (PCPC) and 18% as mild disability. During their PICU stay 53% of children screened positive on at least one delirium screener; mean days positive screen = 1.4 (SD=1.9). At time of transfer children scored at < 50th percentile on all domains of the CMS: attention-concentration mean = 35.1% and 42.1%; visuospatial 41.4% and 34.9%; memory 11.5% and 35.1%. There was no significant difference between children with or without delirium on cognitive function. At follow up children’s cognitive function had improved: attention- concentration mean = 47.3% and 48.6%; visuospatial 50.4% and 59.4%; memory 21.2% and 53.3%; again there was no association with delirium status. Overall there was a significant positive correlation between children’s cognitive function at baseline and at follow up.
Conclusions: More than half of children in this population screened positive for delirium during their PICU stay. At time of transfer from the PICU children show impairment in multiple areas of cognitive function, but this is not associated with delirium. While children’s cognitive function improves over time, children with worse function continue to have worse function 3 months later. Long-term investigation into the neurocognitive effects of pediatric critical illness and its treatment must continue beyond 3 months.
Service Performed By