Opioid Use Is Associated with ICU Delirium in Mechanically Ventilated Children
, , , , and | Aug 11, 2020
About this article
Article Category: Research article
Published Online: Aug 11, 2020
Page range: 167 - 174
Received: May 02, 2020
Accepted: Jun 27, 2020
DOI: https://doi.org/10.2478/jccm-2020-0026
Keywords
© 2020 Neha Gupta, Allison Woolley, Saurabh Talathi, Ganisher Davlyatov, Candice Colston, Leslie Hayes, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Firth’s Penalized Maximum Likelihood Logistic Regression (Model 1) evaluating association of delirium with daily medication doses
| Variables | Odds Ratio (OR) | 95% CI | p-value |
|---|---|---|---|
| Age | |||
| <2 years | ref | ||
| 2-4.9 years | 3.759 | 0.379-37.240 | 0.258 |
| 5-11.9 years | 6.515 | 0.812-52.269 | 0.078 |
| >12 years | 25.326 | 2.818-227.635 | |
| Vasoactive use | |||
| No | ref | ||
| Yes | 0.361 | 0.066-1.974 | 0.240 |
| Time spent on ventilator (hours) | 1.004 | 1.001-1.007 | |
| Daily benzodiazepines dose (mg/kg/day) | 1.060 | 0.691-1.625 | 0.791 |
| Daily opioid dose (mg/kg/day) | 1.977 | 1.129-3.463 | |
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 years | 37 (39) | 35 (46) | 2 (11) | |
| 2-4.9 years | 12 (13) | 9 (12) | 3 (16) | |
| 5-11.9 years | 22 (23) | 17 (22) | 5 (26) | |
| ≥ 12 years | 24 (25) | 15 (20) | 9 (47) | |
| Sex | ||||
| Female | 42 (44) | 35 (46) | 7 (37) | 0.470 |
| Male | 53 (56) | 41 (54) | 12 (63) | |
| Ethnicity | ||||
| White | 49 (52) | 39 (51) | 10 (53) | |
| Black | 40 (42) | 34 (45) | 6 (32) | 0.163 |
| Hispanic | 4 (4) | 2 (3) | 2 (11) | |
| Asian | 2 (2) | 1 (1) | 1 (1) | |
| Comorbidity | ||||
| No | 29 (31) | 26 (34) | 3 (16) | 0.166 |
| Yes | 66 (69) | 50 (66) | 16 (84) | |
| Anticholinergic use | ||||
| No | 29 (31) | 25 (33) | 4 (21) | 0.410 |
| Yes | 66 (69) | 51 (67) | 15 (79) | |
| Vasoactive use | ||||
| No | 61 (64) | 53 (70) | 8 (42) | |
| Yes | 34 (36) | 23 (30) | 11 (58) | |
| Developmental delay | ||||
| No | 66 (69) | 50 (66) | 16 (84) | 0.120 |
| Yes | 29 (31) | 26 (34) | 3 (16) | |
| Diagnosis | ||||
| Respiratory failure | 58 (61) | 48 (63) | 10 (53) | |
| Septic shock | 13 (14) | 9 (12) | 4 (21) | 0.673 |
| Status epilepticus | 7 (7) | 6 (8) | 1 (5) | |
| Other | 17 (18) | 13 (17) | 4 (21) | |
| Time spent on ventilator (hours) | 171 (102-360) | 153 (94-282) | 349 (171-987) | |
| Length of PICU stay (days) | 9 (6-18) | 8 (5-14) | 16 (9-41) | |
| Daily benzodiazepine dose (mg/kg/day) | 2 (0-3) | 1 (0-3) | 2 (2-4) | |
| Cumulative benzodiazepine dose (mg/kg) | 15 (2-34) | 9 (2-28) | 33 (18-77) | |
| Daily opioid dose (mg/kg/day) | 2 (1-3) | 1 (0-3) | 3 (1-4) | |
| Cumulative opioid dose (mg/kg) | 16 (4-33) | 13 (3-24) | 37 (24-70) | |
| 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 ROM | 2 (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
| Variables | Odds Ratio (OR) | 95% CI | p-value |
|---|---|---|---|
| Age | |||
| <2 years | ref | ||
| 2-4.9 years | 2.055 | 0.210-20.070 | 0.536 |
| 5-11.9 years | 4.330 | 0.617-30.386 | 0.140 |
| >12 years | 13.122 | 1.842-93.487 | |
| Vasoactive use | |||
| No | ref | ||
| Yes | 0.445 | 0.085-2.330 | 0.338 |
| Time spent on ventilator (hours) | 1.002 | 0.999-1.004 | 0.143 |
| Cumulative benzodiazepine dose (mg/kg) | 1.003 | 0.995-1.012 | 0.401 |
| Cumulative opioid dose (mg/kg) | 1.035 | 1.005-1.066 | |