State of the science in pediatric ICU delirium: An integrative review.

Most included studies were observational, so they show association but cannot prove that a risk factor caused delirium. Delirium screening methods varied, and some tools were not validated in children. Some studies screened only once daily, which could miss fluctuating delirium. Reliance on psychiatric referral may have missed hypoactive delirium. Consent was often obtained after ICU admission, so children may already have been delirious before study entry. Several studies did not report missing data or dropouts, or test whether missing cases differed. Intervention studies had no control group or did not report compliance with individual bundle components. One person performed searching, selection, extraction, and risk of bias assessment, although a second author discussed uncertainties. Long-term cognitive and functional outcomes were assessed in only a small pilot sample. The review excluded clinician surveys and tool-development reports, so it does not summarize those areas.

The supplied metadata lists NIH extramural research support. No author conflict-of-interest statement is provided.

Do not read the reported decrease after bundle implementation as proof that any single component works. The bundle included validated delirium and pain screening tools, identification of potential delirium etiologies, sedation protocols, avoidance of deliriogenic medications, reorientation, environmental modification, progressive mobilization, family presence, and sleep promotion, and the contribution of any single component cannot be separated.