Over the past decade, delirium ? identified as an unexplained alteration in cognitive function as a result of another clinical condition ? has become recognized as a public health emergency for adults with critical illnesses. In this patient population, delirium is associated with mortality, morbidity, increased length of hospital stays and increased health care costs. We have developed a delirium screening tool to assess delirium in children of all ages. This score, the Cornell Assessment of Pediatric Delirium, has been validated with several psychiatrists at Cornell University and is starting to be used as a part of clinical care. While the development of delirium is multifactorial, sedatives represent a modifiable risk factor for clinicians to consider. To date, there is no pharmacokinetic information to guide clinicians on which sedatives are linked to delirium development. Based on extensive preliminary evidence, we suspect that benzodiazepine-based sedation is related to delirium development and may be affected by drug clearance and serum concentrations. We will also determine if other commonly used narcotics and other agents are associated with delirium development independent of benzodiazepine effects. We will test these two specific aims in a multi-centered (n = 3) study with analysis done at the University of Pittsburgh and University of Buffalo.
Delirium is recognized as a significant contributor to morbidity and mortality for critically ill adults and children. Based on strong preliminary data, this study proposes that benzodiazepines metabolism contributes to the development of delirium in critically-ill children. Moreover, we propose that other sedatives do not play a significant role in the development of pediatric delirium. As a modifiable risk factor, determining the pathophysiological role of benzodiazepines in delirium development can lead to marked improvements in patient care and outcomes in the future.