Aims & Objectives

Intensive care units (ICU) are often described as chaotic because of their bright lights and incessant alarms. Light and sound is associated with sleep disruption and sleep loss, with reports of adult ICU patients averaging 5 hours of sleep with 38 interruptions. Sleep disruption has also been associated with delirium. Delirium is an alteration in both cognition and arousal. In children, delirium was detected in 38% of patients who were in the PICU for six or more days. Pediatric delirium is a significant complication of critical illness and is associated with poor health outcomes, increased medical costs, and prolonged hospitalization.

The purpose of this prospective pilot study is to examine the environment, bio-physiologic responses, and medication use and the role they play in contributing to delirium risk in children admitted to the PICU.

Methods

The study has institutional approval and will enroll 50 children (0-18 years) admitted to the PICU for assisted ventilation. Children with history of toxic exposures, known psychiatric disorders and/or sleep affective disorders will be excluded. Data collection will occur in the first 10 days of PICU hospitalization and will include the following: 1) continuous commercial sensor and bedside monitoring data; 2) EHR data; 3) delirium, RASS and pain scores; 4) administered sedative and analgesic medications; and 5) biologic collections (opt-in).

Results

Data collection is ongoing and preliminary trend/pattern data will be presented.

Conclusions

Understanding the PICU environment’s relationship to delirium risk would allow strategies to be developed that could promote quality sleep, reduce delirium, and improve health outcomes.