J Pediatr Intensive Care 2020; 09(02): 119-123
DOI: 10.1055/s-0039-3400458
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Management of Hyperactive Delirium in the Pediatric Intensive Care Unit: Case Series of Three Young Children

Anna O. Jesus
1   Division of Neurodevelopmental and Behavioral Pediatrics, University of Virginia, Charlottesville, Virginia, United States
,
Lotte Jones
2   Division of Pediatric Critical Care, Children's Hospital of the King's Daughters, Norfolk, Virginia, United States
,
Rebecca Linares
3   Division of Pediatric Critical Care, University of Virginia, Charlottesville, Virginia, United States
,
Marcia L. Buck
4   American College of Clinical Pharmacy, Washington, DC, United States
,
Deborah U. Frank
3   Division of Pediatric Critical Care, University of Virginia, Charlottesville, Virginia, United States
› Author Affiliations
Further Information

Publication History

28 June 2019

12 October 2019

Publication Date:
21 November 2019 (online)

Abstract

Children in the intensive care unit (ICU) are at high risk of developing delirium, given their underlying disease processes, the adverse effects of treatments and medications, and the stressful, abnormal environment. If prevention and nonpharmacologic measures to treat delirium are unsuccessful, atypical antipsychotics are considered, although they are not approved by Food and Drug Administration for the treatment of pediatric delirium and could have significant adverse side effects. This case report presents three pediatric patients with hyperactive ICU delirium that risked life-threating complications who were successfully treated with short courses of atypical antipsychotic medications.

 
  • References

  • 1 Schieveld JN, Janssen NJ. Delirium in the pediatric patient: on the growing awareness of its clinical interdisciplinary importance. JAMA Pediatr 2014; 168 (07) 595-596
  • 2 Silver G, Traube C, Gerber LM. , et al. Pediatric delirium and associated risk factors: a single-center prospective observational study. Pediatr Crit Care Med 2015; 16 (04) 303-309
  • 3 Traube C, Silver G, Reeder RW. , et al. Delirium in critically ill children: an international point prevalence study. Crit Care Med 2017; 45 (04) 584-590
  • 4 Patel AK, Bell MJ, Traube C. Delirium in pediatric critical care. Pediatr Clin North Am 2017; 64 (05) 1117-1132
  • 5 Turkel SB. Pediatric delirium: recognition, management, and outcome. Curr Psychiatry Rep 2017; 19 (12) 101
  • 6 Uçok A, Gaebel W. Side effects of atypical antipsychotics: a brief overview. World Psychiatry 2008; 7 (01) 58-62
  • 7 Girard TD, Exline MC, Carson SS. , et al; MIND-USA Investigators. Haloperidol and ziprasidone for treatment of delirium in critical illness. N Engl J Med 2018; 379 (26) 2506-2516
  • 8 Hui TS, Wong A, Wijesinghe R. A review on mortality risks associated with antipsychotic use in behavioral and psychologic symptoms of dementia (BPSD). Ment Health Clin 2016; 6 (05) 215-221
  • 9 Ray WA, Stein CM, Murray KT. , et al. Association of antipsychotic treatment with risk of unexpected death among children and youths. JAMA Psychiatry 2019; 76 (02) 162-171
  • 10 Traube C, Augenstein J, Greenwald B, LaQuaglia M, Silver G. Neuroblastoma and pediatric delirium: a case series. Pediatr Blood Cancer 2014; 61 (06) 1121-1123
  • 11 Skrobik Y, Duprey MS, Hill NS, Devlin JW. Low-dose nocturnal dexmedetomidine prevents icu delirium. a randomized, placebo-controlled trial. Am J Respir Crit Care Med 2018; 197 (09) 1147-1156
  • 12 Zhu M, Wang H, Zhu A, Niu K, Wang G. Meta-analysis of dexmedetomidine on emergence agitation and recovery profiles in children after sevoflurane anesthesia: different administration and different dosage. PLoS One 2015; 10 (04) e0123728
  • 13 Devlin JW, Roberts RJ, Fong JJ. , et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 2010; 38 (02) 419-427
  • 14 Traube C, Witcher R, Mendez-Rico E, Silver G. Quetiapine as treatment for delirium in critically ill children: a case series. J Pediatr Intensive Care 2013; 2 (03) 121-126
  • 15 Silver GH, Kearney JA, Kutko MC, Bartell AS. Infant delirium in pediatric critical care settings. Am J Psychiatry 2010; 167 (10) 1172-1177
  • 16 Joyce C, Witcher R, Herrup E. , et al. Evaluation of the safety of quetiapine in treating delirium in critically ill children: a retrospective review. J Child Adolesc Psychopharmacol 2015; 25 (09) 666-670
  • 17 Turkel SB, Jacobson JR, Tavaré CJ. The diagnosis and management of delirium in infancy. J Child Adolesc Psychopharmacol 2013; 23 (05) 352-356
  • 18 Edwards LE, Hutchison LB, Hornik CD, Smith PB, Cotten CM, Bidegain M. A case of infant delirium in the neonatal intensive care unit. J Neonatal Perinatal Med 2017; 10 (01) 119-123
  • 19 Smith HA, Gangopadhyay M, Goben CM. , et al. The preschool confusion assessment method for the ICU: valid and reliable delirium monitoring for critically ill infants and children. Crit Care Med 2016; 44 (03) 592-600
  • 20 Kelly P, Frosch E. Recognition of delirium on pediatric hospital services. Psychosomatics 2012; 53 (05) 446-451
  • 21 Smith HA, Boyd J, Fuchs DC. , et al. Diagnosing delirium in critically ill children: validity and reliability of the pediatric confusion assessment method for the Intensive Care Unit. Crit Care Med 2011; 39 (01) 150-157
  • 22 Traube C, Silver G, Kearney J. , et al. Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Crit Care Med 2014; 42 (03) 656-663
  • 23 Silver G, Kearney J, Traube C, Hertzig M. Delirium screening anchored in child development: the Cornell Assessment for Pediatric Delirium. Palliat Support Care 2015; 13 (04) 1005-1011
  • 24 Brahmbhatt K, Whitgob E. Diagnosis and management of delirium in critically ill infants: case report and review. Pediatrics 2016; 137 (03) e20151940
  • 25 Ratcliff SL, Meyer III WJ, Cuervo LJ, Villarreal C, Thomas CR, Herndon DN. The use of haloperidol and associated complications in the agitated, acutely ill pediatric burn patient. J Burn Care Rehabil 2004; 25 (06) 472-478
  • 26 Turkel SB, Jacobson J, Munzig E, Tavaré CJ. Atypical antipsychotic medications to control symptoms of delirium in children and adolescents. J Child Adolesc Psychopharmacol 2012; 22 (02) 126-130
  • 27 Rummel-Kluge C, Komossa K, Schwarz S. , et al. Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis. Schizophr Res 2010; 123 (2,3): 225-233
  • 28 Turkel SB, Hanft A. The pharmacologic management of delirium in children and adolescents. Paediatr Drugs 2014; 16 (04) 267-274