Delirium in Pediatric Patients With Respiratory Insufficiency Requiring Noninvasive Ventilation

BACKGROUND: Delirium is associated with increased length of stay, duration of mechanical ventilation, in-hospital mortality, and cost. Independent predictors of delirium include age < 2 years, developmental delay, severity of illness, mechanical ventilation, and administration of benzodiazepines and anticholinergic medications. Although patients receiving noninvasive ventilation (NIV) may have been included in prior studies, there are no data specifically focusing on delirium in children receiving NIV. Our primary aim was to investigate the prevalence of delirium in patients on NIV in the pediatric intensive care unit (PICU) and evaluate potentially modifiable risk factors for delirium. METHODS: This was a single-center, retrospective study evaluating the prevalence of delirium as established by the Cornell Assessment of Pediatric Delirium (CAPD). We evaluated PICU patients ≤ 18 years old with respiratory insufficiency requiring ≥ 48 h of NIV. Patients receiving invasive mechanical ventilation were excluded from the analysis. RESULTS: There were 202 patients that received ≥ 48 h of NIV during the study period. Of these patients, 43 patients had at least one CAPD score documented while on NIV. There were a total of 143 days on NIV and 137 days with CAPD documentation. The prevalence of delirium, defined as a CAPD score ≥ 9, was 67.4% (29 of 43 patients). Sixty-nine percent of the patients who experienced delirium received benzodiazepines, compared with 14% who did not experience delirium (P = 0.001). Most patients (83.7%) in this cohort received dexmedetomidine. Of patients who received dexmedetomidine and had delirium, 68% received benzodiazepines compared to 25% in the non-delirious group (P = 0.046). CONCLUSIONS: Delirium is common in young pediatric patients receiving NIV. As previously shown in the invasive mechanical ventilation population, benzodiazepine exposure continues to be a potentially modifiable risk factor for delirium.