CICU, PCU, and PICU Clinical Pathway for Screening/Treatment of Children with Delirium
All Children in CICU, PICU, PCU
- Screen for delirium
- Complete Cornell Assessment of Pediatric Delirium (CAPD) 2x day
- Institute Preventative Measures
- Interpreting the CAPD Score
- Developmental Anchors to guide screening ≤ 2 yrs
Positive Screen
(CAPD ≥ 9)
RN notify hospital provider
(CAPD ≥ 9)
RN notify hospital provider
Negative Screen
(CAPD < 9)
(CAPD < 9)
- Complete medical evaluation
- Evaluate using BRAIN MAPS
- Obtain baseline ECG
- Indications for Psychiatry Consult
Delirium Present
Begin 3-prong treatment approach guided by BRAIN MAPSDelirium Not Present
- Continue:
- Preventive Measures
- CAPD screening twice daily
- Trend score over time
- If increasing or not improving, reconsider differential diagnosis
Address
Underlying
Disease
Underlying
Disease
Minimize
Iatrogenic
Factors
Iatrogenic
Factors
Optimize
Environment
Environment
- Consider trial of pharmacologic therapy if at risk for self-harm, device dislodgement or severe symptoms
- Assess for resolution and continue preventative measures
- Continue CAPD screening 2x daily
- If pharmacologic therapy started
- Evaluate ability to wean no later than 5-7 days post-initiation
- Consult psychiatry for management if transferred out of ICU to inpatient floor
- In general, do not discharge home on medications for delirium
Evidence
- Pediatric Delirium
- Delirium in Children & Adolescents: AACAP
- Pediatric Delirium: Monitoring and Management in the Pediatric Intensive Care Unit
- Cornell Assessment of Pediatric Delirium: a Valid, Rapid, Observational Tool for Screening Delirium in the PICU
- Delirium in Children: Identification, Prevention, and Management
Related Links