Detecting delirium among small patients in the Pediatric Intensive
Care Unit is tricky, since children are often heavily sedated and may
not be able to articulate their visions or fears
“Any child who is exposed to the chaotic ICU environment, with
constant light, noise, sedative medications, and resultant sleep
disturbances, is at major risk for delirium,” says Johns Hopkins’
Sapna Kudchadkar, an assistant professor of pediatric anesthesiology
and critical care. “We’re developing tools for identifying it. It
brings in a whole new set of challenges,” she says, noting a recent
survey she conducted involving PICUs around the world. Less than 2
percent of 341 pediatricians surveyed regularly screen children for
delirium.
Kudchadkar is particularly interested in how sleep can affect
outcomes—including delirium—in critically ill children. “Sleep
plays a key role in regulation of multiple organ systems, including
the immune system.
Therefore sleep disturbances may be detrimental to
a child trying to recover from a major illness,” she says. She is
currently conducting a study using EEG to characterize the sleep
experience of critically ill children in the PICU, and actigraphy to
demonstrate the sleep-wake cycles of children after critical illness
or major surgery. Better understanding of the sleep dynamic,
Kudchadkar believes, will enable PICU physicians to design more
effective interventions to optimize sleep—and reduce delirium.
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