CICU, PCU, and PICU Clinical Pathway for Screening/Treatment of Children with Delirium

 
Goals and Metrics
Provider Resources
  • 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
     
Screen for Delirium Twice Daily with
Cornell Assessment of Pediatric Delirium (CAPD) Scale
     
 
 
 
 
     
Positive Screen
(CAPD ≥ 9)
     
Negative Screen
(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
 
 
 
 
  • 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):
     
Delirium Diagnosed: Begin 3-Prong Treatment Approach
     
     

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