Understanding Delirium after Cardiac Arrest in Children

Agitation, pain, and withdrawal…is this normal?

People, both adults and children, admitted to the intensive care units (ICU) could become confused, hear or see things that are not there, get agitated, restless, have trouble sleeping, or become quiet and withdrawn. This condition is called ICU delirium. It can happen in approximately 2 out of 5 pediatric patients and is more common in those who have required breathing support through a machine or the use of certain medications. It is important to note that multiple things contribute to this condition such as recent use of sedating medications, infections, lower oxygen levels, disturbed sleep cycle, and severe pain.

What does ICU delirium look like?

Delirium can look different on everyone. Your child may have trouble focusing, is restless or agitated, have difficulty sleeping, appear quiet, and be disengaged in what is happening around them.

For most children, delirium resolves within a few days, but it may persist if your child has been in the ICU for a long time or is very sick. Research shows that these thinking and behavioral difficulties can last for months after delirium has resolved. Children most at risk for developing delirium are those under age 5, as well as those with neurological disorders, developmental delays, or who need restraints or certain medications.

How will the medical team treat ICU delirium?

ICU delirium will be addressed in multiple ways, as no single medication or treatment will immediately cure it. Your child’s healthcare team will first try to investigate any potential causes of the delirium, such as an infection or medications your child is taking, that can be treated or removed. They will assess pain or fever. If confused or disoriented, they will try to help them understand where they are and why they are there. The healthcare team will also use the following strategies to help treat delirium:

• • Minimizing blood draws and other tests during that night so that your child can sleep and have meaningful rest
  • Opening the blinds during the day so that sunlight can enter the room (letting the brain know it is daytime and they should be awake) 
  • Reducing noise and promoting a comfortable environment 
  • Removing any devices, tubes, or medical equipment that are not necessary for care, when it is safe to do so
  • Helping your child move and walk (if appropriate) as soon as possible, to reduce the effects of prolonged bed rest

If the above items do not help with delirium, the medical team may also start medications to help with sleep so your child regains a normal sleep pattern. With enough rest and time, your child may be able to slowly return to a healthy state of mind.

Is there anything I can do to help my child if they are experiencing ICU delirium?

There are a few things you can do to help and comfort your child if they are experiencing ICU delirium.

• • Be present and participate in care as appropriate.
  • Remain calm and keep conversations simple so that they feel comforted and at ease.
  • When you visit, tell them the day, month, and year, where and why they are in the hospital, as age appropriate.
  • Bring a favorite toy or stuffed animal to comfort them.
  • Play their favorite show or their favorite music or read them their favorite book.
  • Have siblings visit often, if appropriate and allowed in the hospital setting.
  • Open blinds during the day to ensure sunlight comes in and turn lights and TV off at night to minimize sleep interruptions.

Sources

Barry, A. (2022, October 20). Pediatric delirium: Combating brain dysfunction. American Association of Critical-Care Nurses (AACN) Blog. https://www.aacn.org/blog/pediatric-delirium-combating-brain-dysfunction 

Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center. (n.d.). Patients and families overview. https://www.icudelirium.org/patients-and-families/overview

Liviskie, C., McPherson, C., & Luecke, C. (2021). Assessment and management of delirium in the pediatric intensive care unit: A review. Journal of Pediatric Intensive Care, 12(2), 94–105. https://doi.org/10.1055/s-0041-1730918 

Silver, G., Doyle, H., Hegel, E., Kaur, S., Mauer, E.A, Gerber, L.M., & Traube, C. (2020). Association between pediatric delirium and quality of life after discharge. Critical Care Medicine, 48(12), 1829-1834. https://doi.org/10.1097/CCM.0000000000004661 

Smith, H. A., Besunder, J. B., Betters, K. A., Johnson, P., Srinivasan, V., Stormorken, A., Farrington, E., …Berkenbosch, J. W. (2022). 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatric Critical Care Medicine, 23(2), 74-110. https://doi.org/10.1097/PCC.0000000000002873 

Staveski, S. L., Pickler, R. H., Lin, L., Shaw, R. J., Meinzen-Derr, J., Redington, A., & Curley, M. A. Q. (2018). Management of pediatric delirium in pediatric cardiac intensive care patients: An international survey of current practices. Pediatric Critical Care Medicine, 19(6), 538–543. https://doi.org/10.1097/PCC.0000000000001558

Thank you to our contributors

Kelly Bouthillet & Samantha Fernandez