J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 9, September 2022, pages 357-363

Delirium in Pediatric Patients With Respiratory Insufficiency Requiring Noninvasive Ventilation

**Table 1.** Demographic Data of Patients With and Without Delirium^a
Variable	No delirium (n = 14)	Delirium^a (n = 29)	P value
Data are presented as median (range) and n (%). P values are calculated using Wilcoxon rank sum test or Fisher’s exact test. ^aPositive delirium screen based on CAPD ≥ 9. CAPD: Cornell Assessment of Pediatric Delirium.
Age (years)	0 (0, 10)	1 (0, 17)	0.631
< 1	8 (57%)	14 (46%)	0.965
1 - 2	4 (29%)	10 (35%)
2 - 4	1 (7%)	3 (11%)
5 - 9	0	1 (4%)
≥ 10	1 (7%)	1 (4%)
Gender			0.099
Female	11 (79%)	14 (48%)
Male	3 (21%)	15 (52%)
Race			0.475
White	10 (71%)	22 (76%)
Black	2 (14%)	6 (21%)
Other	2 (14%)	1 (3%)
Baseline developmental delay	0	3 (11%)
Primary diagnosis			1.000
Viral bronchiolitis	13 (93%)	25 (86%)
Pneumonia	0	3 (10%)
Influenza A	1 (7%)	0
Status asthmaticus	0	1 (3%)
Type of gastric tube			0.308
None	11 (79%)	17 (59%)
Nasogastric tube	3 (21%)	12 (41%)
Daily feeding			1.000
Enteral	4 (29%)	7 (24%)
None	10 (71%)	22 (76%)

Table 1. Demographic Data of Patients With and Without Delirium^a

Variable

No delirium (n = 14)

Delirium^a (n = 29)

P value

Data are presented as median (range) and n (%). P values are calculated using Wilcoxon rank sum test or Fisher’s exact test. ^aPositive delirium screen based on CAPD ≥ 9. CAPD: Cornell Assessment of Pediatric Delirium.

Age (years)

0 (0, 10)

1 (0, 17)

0.631

< 1

8 (57%)

14 (46%)

0.965

1 - 2

4 (29%)

10 (35%)

2 - 4

1 (7%)

3 (11%)

5 - 9

1 (4%)

≥ 10

1 (7%)

1 (4%)

Gender

0.099

Female

11 (79%)

14 (48%)

Male

3 (21%)

15 (52%)

Race

0.475

White

10 (71%)

22 (76%)

Black

2 (14%)

6 (21%)

Other

2 (14%)

1 (3%)

Baseline developmental delay

3 (11%)

Primary diagnosis

1.000

Viral bronchiolitis

13 (93%)

25 (86%)

Pneumonia

3 (10%)

Influenza A

1 (7%)

Status asthmaticus

1 (3%)

Type of gastric tube

0.308

None

11 (79%)

17 (59%)

Nasogastric tube

3 (21%)

12 (41%)

Daily feeding

1.000

Enteral

4 (29%)

7 (24%)

None

10 (71%)

22 (76%)

**Table 2.** Outcome and Additional Clinical Data of Patients With and Without Delirium^a
Variable	No delirium (n = 14)	Delirium^a (n = 29)	P value
Data are presented as median (range) and n (%). When considering the type of NIV, the values may add up to more than the n as a single patient may have transitioned from one type of NIV to another during their hospital course. P values are calculated using Wilcoxon rank sum test or Fisher’s exact test. ^aPositive delirium screen based on CAPD ≥ 9. ^bP values comparing the no delirium and delirium groups on each modality of NIV. PICU: pediatric intensive care unit; NIV: noninvasive ventilation; BiPAP: bilevel positive airway pressure; CPAP: continuous positive airway pressure; HFNC: high-flow nasal cannula; CAPD: Cornell Assessment of Pediatric Delirium.
Number of days in the hospital	5.5 (3, 10)	6 (3, 14)	0.535
Total number of days in the hospital	83	191
Number of days in the PICU	3 (1, 6)	3 (2, 13)	0.053
Total number of days in the PICU	43	123
Number of days on NIV	2 (2, 5)	3 (2, 12)	0.152
Total number of days on NIV	39	104
Type of NIV
BiPAP	5 (35%)	21 (72%)	0.044^b
CPAP	0	2 (7%)	1.000^b
HFNC	11 (79%)	16 (55%)	0.187^b
Average daily inspired oxygen concentration (%)	26 (19 - 33)	26 (18 - 34)	0.864
Reason for NIV discontinuation
Weaned off	14 (100%)	29 (100%)
Number of days with delirium^a	0	2 (1, 6)
Total number of days with delirium^a	0	74
Number of days CAPD documented	2 (1, 4)	3 (2, 9)
Total number of days CAPD documented	31	106

Table 2. Outcome and Additional Clinical Data of Patients With and Without Delirium^a

Variable

No delirium (n = 14)

Delirium^a (n = 29)

P value

Data are presented as median (range) and n (%). When considering the type of NIV, the values may add up to more than the n as a single patient may have transitioned from one type of NIV to another during their hospital course. P values are calculated using Wilcoxon rank sum test or Fisher’s exact test. ^aPositive delirium screen based on CAPD ≥ 9. ^bP values comparing the no delirium and delirium groups on each modality of NIV. PICU: pediatric intensive care unit; NIV: noninvasive ventilation; BiPAP: bilevel positive airway pressure; CPAP: continuous positive airway pressure; HFNC: high-flow nasal cannula; CAPD: Cornell Assessment of Pediatric Delirium.

Number of days in the hospital

5.5 (3, 10)

6 (3, 14)

0.535

Total number of days in the hospital

191

Number of days in the PICU

3 (1, 6)

3 (2, 13)

0.053

Total number of days in the PICU

123

Number of days on NIV

2 (2, 5)

3 (2, 12)

0.152

Total number of days on NIV

104

Type of NIV

BiPAP

5 (35%)

21 (72%)

0.044^b

CPAP

2 (7%)

1.000^b

HFNC

11 (79%)

16 (55%)

0.187^b

Average daily inspired oxygen concentration (%)

26 (19 - 33)

26 (18 - 34)

0.864

Reason for NIV discontinuation

Weaned off

14 (100%)

29 (100%)

Number of days with delirium^a

2 (1, 6)

Total number of days with delirium^a

Number of days CAPD documented

2 (1, 4)

3 (2, 9)

Total number of days CAPD documented

106

**Table 3.** Medications received by patients with and without delirium^a
Medications	No delirium (n = 14)	Delirium^a (n = 29)	P value
Data are presented as median (range) and n (%). P values are calculated using Wilcoxon rank sum test or Fisher’s exact test. ^aPositive delirium screen based on CAPD ≥ 9. ADS: Anticholinergic Drug Scale; CAPD: Cornell Assessment of Pediatric Delirium.
Benzodiazepines	2 (14%)	20 (69%)	0.001
Lorazepam	2 (14%)	19 (66%)
Midazolam	0	2 (7%)
Diazepam	0	1 (3%)
Dexmedetomidine	8 (57%)	28 (97%)	0.003
Melatonin	1 (7%)	1 (3%)	1.000
Risperidone	0	1 (3%)	1.000
Famotidine	2 (14%)	7 (24%)	0.693
Albuterol	12 (86%)	27 (93%)	0.586
Ipratropium	1 (7%)	7 (24%)	0.240
Corticosteroids	3 (21%)	9 (31%)	0.720
Prednisolone	2 (14%)	6 (21%)
Methylprednisolone	2 (14%)	8 (28%)
Hydrocortisone	0	1 (3%)
Antibiotics	5 (36%)	10 (34%)	1.000
Chloral hydrate	3 (21%)	13 (45%)	0.187
Clonidine	2 (14%)	5 (17%)	1.000
Anticholinergic agents	7 (50%)	23 (79%)	0.077
ADS score	1.5 (1, 3)	2 (1, 6)	0.292

Table 3. Medications received by patients with and without delirium^a

Medications

No delirium (n = 14)

Delirium^a (n = 29)

P value

Data are presented as median (range) and n (%). P values are calculated using Wilcoxon rank sum test or Fisher’s exact test. ^aPositive delirium screen based on CAPD ≥ 9. ADS: Anticholinergic Drug Scale; CAPD: Cornell Assessment of Pediatric Delirium.

Benzodiazepines

2 (14%)

20 (69%)

0.001

Lorazepam

2 (14%)

19 (66%)

Midazolam

2 (7%)

Diazepam

1 (3%)

Dexmedetomidine

8 (57%)

28 (97%)

0.003

Melatonin

1 (7%)

1 (3%)

1.000

Risperidone

1 (3%)

1.000

Famotidine

2 (14%)

7 (24%)

0.693

Albuterol

12 (86%)

27 (93%)

0.586

Ipratropium

1 (7%)

7 (24%)

0.240

Corticosteroids

3 (21%)

9 (31%)

0.720

Prednisolone

2 (14%)

6 (21%)

Methylprednisolone

2 (14%)

8 (28%)

Hydrocortisone

1 (3%)

Antibiotics

5 (36%)

10 (34%)

1.000

Chloral hydrate

3 (21%)

13 (45%)

0.187

Clonidine

2 (14%)

5 (17%)

1.000

Anticholinergic agents

7 (50%)

23 (79%)

0.077

ADS score

1.5 (1, 3)

2 (1, 6)

0.292

**Table 4.** Benzodiazepine Exposure In Patients With and Without Delirium^a Who Received Dexmedetomidine (N = 36)
Medications	No delirium (n = 8)	Delirium^a (n = 28)	P value
Data are presented as median (range) and n (%). P values are calculated using Wilcoxon rank sum test or Fisher’s exact test. ^aPositive delirium screen based on CAPD ≥ 9. CAPD: Cornell Assessment of Pediatric Delirium.
Benzodiazepines	2 (25%)	19 (68%)	0.046
Lorazepam	2 (25%)	19 (68%)
Midazolam	0	2 (7%)
Diazepam	0	0
Total number of lorazepam bolus doses	0.5 (0, 3)	2.8 (0, 10)
Total number of midazolam bolus doses	-	0.07 (0, 1)

Table 4. Benzodiazepine Exposure In Patients With and Without Delirium^a Who Received Dexmedetomidine (N = 36)

Medications

No delirium (n = 8)

Delirium^a (n = 28)

P value

Benzodiazepines

2 (25%)

19 (68%)

0.046

Lorazepam

2 (25%)

19 (68%)

Midazolam

2 (7%)

Diazepam

Total number of lorazepam bolus doses

0.5 (0, 3)

2.8 (0, 10)

Total number of midazolam bolus doses

0.07 (0, 1)