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Opioid Use Is Associated with ICU Delirium in Mechanically Ventilated Children Cover

Opioid Use Is Associated with ICU Delirium in Mechanically Ventilated Children

Open Access
|Aug 2020

Figures & Tables

Firth’s Penalized Maximum Likelihood Logistic Regression (Model 1) evaluating association of delirium with daily medication doses

VariablesOdds Ratio (OR)95% CIp-value
Age
    <2 yearsref
    2-4.9 years3.7590.379-37.2400.258
    5-11.9 years6.5150.812-52.2690.078
    >12 years25.3262.818-227.6350.004
Vasoactive use
    Noref
    Yes0.3610.066-1.9740.240
Time spent on ventilator (hours)1.0041.001-1.0070.007
Daily benzodiazepines dose (mg/kg/day)1.0600.691-1.6250.791
Daily opioid dose (mg/kg/day)1.9771.129-3.4630.017

Descriptive statistics of patients

Overall (N=95) Frequency (%)/ Median (IQR)No Delirium (n=76) Frequency (%)/ Median (IQR)Delirium (n=19) Frequency (%)/ Median (IQR)p-value
Age
    < 2 years37 (39)35 (46)2 (11)0.012
    2-4.9 years12 (13)9 (12)3 (16)
    5-11.9 years22 (23)17 (22)5 (26)
    ≥ 12 years24 (25)15 (20)9 (47)
Sex
    Female42 (44)35 (46)7 (37)0.470
    Male53 (56)41 (54)12 (63)
Ethnicity
    White49 (52)39 (51)10 (53)
    Black40 (42)34 (45)6 (32)0.163
    Hispanic4 (4)2 (3)2 (11)
    Asian2 (2)1 (1)1 (1)
Comorbidity
    No29 (31)26 (34)3 (16)0.166
    Yes66 (69)50 (66)16 (84)
Anticholinergic use
    No29 (31)25 (33)4 (21)0.410
    Yes66 (69)51 (67)15 (79)
Vasoactive use
    No61 (64)53 (70)8 (42)0.033
    Yes34 (36)23 (30)11 (58)
Developmental delay
    No66 (69)50 (66)16 (84)0.120
    Yes29 (31)26 (34)3 (16)
Diagnosis
    Respiratory failure58 (61)48 (63)10 (53)
    Septic shock13 (14)9 (12)4 (21)0.673
    Status epilepticus7 (7)6 (8)1 (5)
    Other17 (18)13 (17)4 (21)
Time spent on ventilator (hours)171 (102-360)153 (94-282)349 (171-987)<0.001
Length of PICU stay (days)9 (6-18)8 (5-14)16 (9-41)<0.001
Daily benzodiazepine dose (mg/kg/day)2 (0-3)1 (0-3)2 (2-4)0.009
Cumulative benzodiazepine dose (mg/kg)15 (2-34)9 (2-28)33 (18-77)<0.001
Daily opioid dose (mg/kg/day)2 (1-3)1 (0-3)3 (1-4)0.023
Cumulative opioid dose (mg/kg)16 (4-33)13 (3-24)37 (24-70)<0.001
Daily dexmedetomidine dose (mcg/kg/day)4 (0-10)4 (1-9)2 (0-10)0.941
Cumulative dexmedetomidine dose (mcg/kg)36 (5-91)35 (3-84)60 (11-118)0.177
Daily steroid dose (mg/kg/day)0 (0-1)0 (0-0)0 (0-0)0.154
Cumulative steroid dose (mg/kg)2 (1-4)2 (1-4)3 (0-5)0.434
PIM 3 ROM2 (1-3)1 (1-3)2 (1-4)0.527

Firth’s Penalized Maximum Likelihood Logistic Regression (Model 2) evaluating association of delirium with cumulative medication doses

VariablesOdds Ratio (OR)95% CIp-value
Age
    <2 yearsref
    2-4.9 years2.0550.210-20.0700.536
    5-11.9 years4.3300.617-30.3860.140
    >12 years13.1221.842-93.4870.010
Vasoactive use
    Noref
    Yes0.4450.085-2.3300.338
Time spent on ventilator (hours)1.0020.999-1.0040.143
Cumulative benzodiazepine dose (mg/kg)1.0030.995-1.0120.401
Cumulative opioid dose (mg/kg)1.0351.005-1.0660.022
DOI: https://doi.org/10.2478/jccm-2020-0026 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 167 - 174
Submitted on: May 2, 2020
Accepted on: Jun 27, 2020
Published on: Aug 11, 2020
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year

© 2020 Neha Gupta, Allison Woolley, Saurabh Talathi, Ganisher Davlyatov, Candice Colston, Leslie Hayes, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.