CICU, PCU, and PICU Clinical Pathway for Screening/Treatment of Children with Delirium
- Delirium Definition: Delirium is a disturbance of both consciousness and cognition with the cardinal features of
acute change or fluctuation in mental status and inattention. - Clinical Application: Delirium is a diagnosis that is due to an underlying pathophysiological abnormality leading to an imbalance in neurotransmitters in the brain. The underlying cause must be addressed before the delirium will resolve.
- Exclusions from Screening
- Neuromuscular blockade
- Documented SBS -2 or -3
All CICU/PICU/PCU Patients: Institute Preventative Measures
Positive Screen
(CAPD ≥ 9)
(CAPD ≥ 9)
Negative Screen
(CAPD < 9)
(CAPD < 9)
- RN to notify FLOC
CICU/PICU/PCU Clinical Team to Assess Patient Within
2-4 Hours of Screen: Evaluate Patient Using BRAIN MAPS
2-4 Hours of Screen: Evaluate Patient Using BRAIN MAPS
- Medical Evaluation
- Obtain Baseline EKG
- Indications for Psychiatry Consult with/out
Developmental and Behavioral Pediatrics
- Delirium Not Diagnosed:
If CAPD ≥ 9 and provider determines (to their best ability) that the patient does not have delirium or has modifiable risk factors (e.g. symptoms of agitation related to untreated pain):- Continue CAPD screening twice daily
- BRAIN MAPS can help determine other factors to modify
- Continue to trend score over time. If increasing or not improving, reconsider diagnosis and see Additional Differential Diagnostic Considerations
Delirium Diagnosed: Begin 3-Prong Treatment Approach
- Use BRAIN MAPS to guide:
Address
Underlying
Disease
Minimize
Iatrogenic
Factors
Optimize
Environment
- Consider Trial of Pharmacologic Therapy for:
- Patients at risk for Self-harm/Device Dislodgement
- Those not at risk for self-harm may still benefit from some therapies
- Assess for Resolution and continue Preventative Measures
- Continue CAPD Screening Twice Daily While In CICU/PICU
- If pharmacologic therapy started, evaluate ability to discontinue no
later than 5-7 days post-initiation
- Patients who are not at risk to themselves but are on pharmacologic therapy can be managed outside of the ICU in consultation with Psychiatry without the need to continue twice daily CAPD screening.
Posted: July 2016
Last Revised: March 2024
Authors: H. Wolfe, MD; A. Mack, MD; K. Papili, CNS; S. Frese, RN; J. Strohm Farber, DNP; B. Blowey, PharmD
Last Revised: March 2024
Authors: H. Wolfe, MD; A. Mack, MD; K. Papili, CNS; S. Frese, RN; J. Strohm Farber, DNP; B. Blowey, PharmD
Evidence
- Pediatric Delirium
- Delirium in Children & Adolescents: AACAP
- Pediatric delirium: monitoring and management in the pediatric intensive care unit
- Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU
- Delirium in children: identification, prevention, and management