Our study included all patients admitted to the PICU between 1 September 2014 through 31 December 2018 who were transfused platelets within 14 days of being admitted. We utilized delirium data collected prospectively in an urban, academic, mixed pediatric critical care unit. Procedures for the study were followed in accordance with the ethical standards of the Institutional Review Board on human experimentation and with the Helsinki Declaration of 1975. The Weill Cornell Medicine Institutional Review Board approved this study titled “Association Between Platelet Transfusions and Pediatric Delirium” (protocol 1807019459) on 16 January 2020. Minimizing platelet transfusions as much as clinically feasible may decrease delirium risk in critically ill children. We reported an independent association between platelet transfusion and next-day delirium/coma after accounting for time-dependent confounders, with a dose–response effect.
For every 1 cc/kg of platelet transfused, odds of next-day delirium increased by 9% (odds ratio 1.09, 95% CI 1.03–1.51). MSM demonstrated a 75% increase in the development of next-day delirium after transfusion of platelets (aOR 1.75, 95% CI 1.03–2.97).
To account for time-dependent confounding, a marginal structural model (MSM) was constructed to delineate the relationship between platelet transfusion and next-day delirium. Data obtained included severity of illness, level of respiratory support, exposure to medications and blood products, as well as daily cognitive status. We performed a single-center retrospective cohort analysis including children admitted to the PICU between 20 who were transfused platelets within the first 14 days of admission. We hypothesized that receipt of platelets would be associated with delirium development in a pediatric intensive care unit (PICU). Platelet transfusions may potentiate the body’s pro-inflammatory responses. Inflammation has been implicated as a mechanism for the development of delirium.
Delirium is a frequent, serious, and preventable complication in critically ill children.
0 kommentar(er)
