Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients
Abstract Despite global consensus on the importance of screening pediatric delirium, correlations between pediatric delirium during acute brain injury and adult delirium are unclear. Therefore, we hypothesized that similar pediatric biomarkers reflect acute brain injury as in adult delirium. We obse...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2022-11-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-22702-2 |
| _version_ | 1828156116610056192 |
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| author | Yujiro Matsuishi Haruhiko Hoshino Yuki Enomoto Nobutake Shimojo Muneaki Matsubara Hideyuki Kato Bryan J. Mathis Kojiro Morita Yuji Hiramatsu Yoshiaki Inoue |
| author_facet | Yujiro Matsuishi Haruhiko Hoshino Yuki Enomoto Nobutake Shimojo Muneaki Matsubara Hideyuki Kato Bryan J. Mathis Kojiro Morita Yuji Hiramatsu Yoshiaki Inoue |
| author_sort | Yujiro Matsuishi |
| collection | DOAJ |
| description | Abstract Despite global consensus on the importance of screening pediatric delirium, correlations between pediatric delirium during acute brain injury and adult delirium are unclear. Therefore, we hypothesized that similar pediatric biomarkers reflect acute brain injury as in adult delirium. We observed pediatric cardiac surgery patients from neonatal age to 18 years, who were admitted to our pediatric intensive care unit after cardiovascular operations between October 2019 to June 2020, up to post-operative day 3 (4 days total). We recorded age, sex, risk score (Risk Adjustment in Congenital Heart Surgery [RACHS-1]), midazolam/dexmedetomidine/fentanyl dosage, and pediatric Sequential Organ Failure Assessment (pSOFA). Richmond Agitation-Sedation Scale (RASS), Cornell Assessment of Pediatric Delirium (CAPD), Face, Leg, Activity, Consolability (FLACC) behavioral scale, and Withdrawal Assessment Tool (WAT-1) scales were used and serum sampling for neuron specific enolase (NSE) was conducted. Consciousness status was considered hierarchical (coma > delirium > normal) and associations between conscious status and NSE were conducted by hierarchical Bayesian modeling. We analyzed 134 data points from 40 patients (median age 12 months). In the multi-regression model, NSE was positively associated with coma [posterior odds ratio (OR) = 1.1, 95% credible interval (CrI) 1.01–1.19] while pSOFA [posterior OR = 1.63, 95% CrI 1.17–2.5], midazolam [posterior OR = 1.02, 95% CrI 1.01–1.04], and dexmedetomidine [posterior OR = 9.52, 95% CrI 1.02–108.85] were also associated. We also evaluated consciousness state probability at each NSE concentration and confirmed both that consciousness was hierarchically sorted and CAPD scores were also associated with NSE [posterior OR = 1.32, 95% CrI 1.09–1.58]. “Eye contact” (r = 0.55) was the most correlated component with NSE within the pain, withdrawal syndrome, and PD items. PD within the hierarchy of consciousness (coma, delirium, normal) and CAPD scores are associated with brain injury marker levels. Using pediatric delirium assessment tools for monitoring brain injury, especially eye contact, is a reliable method for observing PD. |
| first_indexed | 2024-04-11T23:05:15Z |
| format | Article |
| id | doaj.art-498d867997c04f8391946cc98b49a1e8 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-11T23:05:15Z |
| publishDate | 2022-11-01 |
| publisher | Nature Portfolio |
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| spelling | doaj.art-498d867997c04f8391946cc98b49a1e82022-12-22T03:58:02ZengNature PortfolioScientific Reports2045-23222022-11-0112111110.1038/s41598-022-22702-2Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patientsYujiro Matsuishi0Haruhiko Hoshino1Yuki Enomoto2Nobutake Shimojo3Muneaki Matsubara4Hideyuki Kato5Bryan J. Mathis6Kojiro Morita7Yuji Hiramatsu8Yoshiaki Inoue9Neuroscience Nursing, St. Luke’s International UniversityAdult Health Nursing, Department of Nursing, International University of Health and WelfareDepartment of Emergency and Critical Care Medicine, Faculty of Medicine, University of TsukubaDepartment of Emergency and Critical Care Medicine, Faculty of Medicine, University of TsukubaDepartment of Cardiovascular Surgery, University of TsukubaDepartment of Cardiovascular Surgery, University of TsukubaInternational Medical Center, University of Tsukuba HospitalGlobal Nursing Research Center, Graduate School of Medicine, The University of TokyoDepartment of Cardiovascular Surgery, University of TsukubaDepartment of Emergency and Critical Care Medicine, Faculty of Medicine, University of TsukubaAbstract Despite global consensus on the importance of screening pediatric delirium, correlations between pediatric delirium during acute brain injury and adult delirium are unclear. Therefore, we hypothesized that similar pediatric biomarkers reflect acute brain injury as in adult delirium. We observed pediatric cardiac surgery patients from neonatal age to 18 years, who were admitted to our pediatric intensive care unit after cardiovascular operations between October 2019 to June 2020, up to post-operative day 3 (4 days total). We recorded age, sex, risk score (Risk Adjustment in Congenital Heart Surgery [RACHS-1]), midazolam/dexmedetomidine/fentanyl dosage, and pediatric Sequential Organ Failure Assessment (pSOFA). Richmond Agitation-Sedation Scale (RASS), Cornell Assessment of Pediatric Delirium (CAPD), Face, Leg, Activity, Consolability (FLACC) behavioral scale, and Withdrawal Assessment Tool (WAT-1) scales were used and serum sampling for neuron specific enolase (NSE) was conducted. Consciousness status was considered hierarchical (coma > delirium > normal) and associations between conscious status and NSE were conducted by hierarchical Bayesian modeling. We analyzed 134 data points from 40 patients (median age 12 months). In the multi-regression model, NSE was positively associated with coma [posterior odds ratio (OR) = 1.1, 95% credible interval (CrI) 1.01–1.19] while pSOFA [posterior OR = 1.63, 95% CrI 1.17–2.5], midazolam [posterior OR = 1.02, 95% CrI 1.01–1.04], and dexmedetomidine [posterior OR = 9.52, 95% CrI 1.02–108.85] were also associated. We also evaluated consciousness state probability at each NSE concentration and confirmed both that consciousness was hierarchically sorted and CAPD scores were also associated with NSE [posterior OR = 1.32, 95% CrI 1.09–1.58]. “Eye contact” (r = 0.55) was the most correlated component with NSE within the pain, withdrawal syndrome, and PD items. PD within the hierarchy of consciousness (coma, delirium, normal) and CAPD scores are associated with brain injury marker levels. Using pediatric delirium assessment tools for monitoring brain injury, especially eye contact, is a reliable method for observing PD.https://doi.org/10.1038/s41598-022-22702-2 |
| spellingShingle | Yujiro Matsuishi Haruhiko Hoshino Yuki Enomoto Nobutake Shimojo Muneaki Matsubara Hideyuki Kato Bryan J. Mathis Kojiro Morita Yuji Hiramatsu Yoshiaki Inoue Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients Scientific Reports |
| title | Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients |
| title_full | Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients |
| title_fullStr | Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients |
| title_full_unstemmed | Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients |
| title_short | Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients |
| title_sort | pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients |
| url | https://doi.org/10.1038/s41598-022-22702-2 |
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