Delirium in the Critically Ill Child: Assessment and Sequelae

Delirium is a common and serious neuropsychiatric complication in critically ill patients of all ages. In the context of critical illness, delirium may emerge as a result of a cascade of underlying pathophysiologic mechanisms and signals organ failure of the brain. Awareness of the clinical importan...

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Bibliographic Details
Published in:Developmental neuropsychology 2017-01, Vol.42 (6), p.387-403
Main Authors: Paterson, Rebecca S., Kenardy, Justin A., De Young, Alexandra C., Dow, Belinda L., Long, Debbie A.
Format: Article
Language:English
Subjects:
Adult
Brain
Child
Children
Complications
Critical Illness
Delirium
Delirium - diagnosis
Humans
Intensive care
Intensive Care Units, Pediatric
long-term outcomes
Mental disorders
Morbidity
parent coping
Pediatrics
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Summary:Delirium is a common and serious neuropsychiatric complication in critically ill patients of all ages. In the context of critical illness, delirium may emerge as a result of a cascade of underlying pathophysiologic mechanisms and signals organ failure of the brain. Awareness of the clinical importance of delirium in adults is growing as emerging research demonstrates that delirium represents a serious medical problem with significant sequelae. However, our understanding of delirium in children lags significantly behind the adult literature. In particular, our knowledge of how to assess delirium is complicated by challenges in recognizing symptoms of delirium in pediatric patients especially in critical and intensive care settings, and our understanding of its impact on acute and long-term functioning remains in its infancy. This paper focuses on (a) the challenges associated with assessing delirium in critically ill children, (b) the current literature on the outcomes of delirium including morbidity following discharge from PICU, and care-giver well-being, and (c) the importance of assessment in determining impact of delirium on outcome. Current evidence suggests that delirium is a diagnostic challenge for clinicians and may play a detrimental role in a child's recovery after discharge from the pediatric intensive care unit (PICU). Recommendations are proposed for how our knowledge and assessment of delirium in children could be improved.
ISSN:8756-5641
1532-6942
DOI:10.1080/87565641.2017.1374961