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.