1
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
,
Robert C. Tasker
1
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
2
Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States
› Author AffiliationsFunding The authors acknowledge that an internal award from the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital has been used for this article.
In sepsis, anticholinergic dysregulation may result in encephalopathy or delirium during severe illness, either as a result of central inflammation or because of exposure to medications with anticholinergic activity. In this retrospective study, we determined the magnitude of anticholinergic drug exposure in 75 children with severe sepsis. We found that exposure over the first 5 days was high—median (interquartile range) daily anticholinergic drug scale score 4 (2–5)—and associated with higher vasoactive scores and death. We conclude that anticholinergic drug exposure is significant in severe sepsis, which means it may be a modifiable factor that should be studied further.
1
Sonneville R,
de Montmollin E,
Poujade J.
et al.
Potentially modifiable factors contributing to sepsis-associated encephalopathy. Intensive Care Med 2017; 43 (08) 1075-1084
3
van Gool WA,
van de Beek D,
Eikelenboom P.
Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 2010; 375 (9716): 773-775
5
Sandquist MK,
Clee MS,
Patel SK.
et al.
High frequency of neuroimaging abnormalities among pediatric patients with sepsis who undergo neuroimaging. Pediatr Crit Care Med 2017; 18 (07) 607-613
7
Garralda ME,
Gledhill J,
Nadel S,
Neasham D,
O'Connor M,
Shears D.
Longer-term psychiatric adjustment of children and parents after meningococcal disease. Pediatr Crit Care Med 2009; 10 (06) 675-680
8
Als LC,
Picouto MD,
Hau SM.
et al.
Mental and physical well-being following admission to pediatric intensive care. Pediatr Crit Care Med 2015; 16 (05) e141-e149
10
Tune L,
Coyle JT.
Serum levels of anticholinergic drugs in treatment of acute extrapyramidal side effects. Arch Gen Psychiatry 1980; 37 (03) 293-297
11
Tsuruta R,
Girard TD,
Ely EW.
et al.
Associations between markers of inflammation and cholinergic blockade and delirium in intensive care unit patients: a pilot study. Bull Yamaguchi Med Sch 2008; 55 (3–4): 35-42
12
Salluh JI,
Soares M,
Teles JM.
et al;
Delirium Epidemiology in Critical Care Study Group.
Delirium epidemiology in critical care (DECCA): an international study. Crit Care 2010; 14 (06) R210
13
Traube C,
Silver G,
Reeder RW.
et al.
Delirium in critically ill children: an international point prevalence study. Crit Care Med 2017; 45 (04) 584-590
14
Traube C,
Silver G,
Gerber LM.
et al.
Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med 2017; 45 (05) 891-898
15
Mehta S,
Cook D,
Devlin JW.
et al;
SLEAP Investigators; Canadian Critical Care Trials Group.
Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med 2015; 43 (03) 557-566
16
Smith HAB,
Gangopadhyay M,
Goben CM.
et al.
Delirium and benzodiazepines associated with prolonged ICU stay in critically ill infants and young children. Crit Care Med 2017; 45 (09) 1427-1435
17
Carnahan RM,
Lund BC,
Perry PJ,
Pollock BG,
Culp KR.
The anticholinergic drug scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol 2006; 46 (12) 1481-1486
19
Goldstein B,
Giroir B,
Randolph A.
International Consensus Conference on Pediatric Sepsis.
International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6 (01) 2-8
21
Bangalore H,
Gaies M,
Ocampo EC.
et al.
The Total Inotrope Exposure Score: an extension of the Vasoactive Inotrope Score as a predictor of adverse outcomes after paediatric cardiac surgery. Cardiol Young 2017; 27 (06) 1146-1152
23
Curley MA,
Harris SK,
Fraser KA,
Johnson RA,
Arnold JH.
State Behavioral Scale: a sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatr Crit Care Med 2006; 7 (02) 107-114
24
Traube C,
Silver G,
Kearney J.
et al.
Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Crit Care Med 2014; 42 (03) 656-663
25
Davis AL,
Carcillo JA,
Aneja RK.
et al.
American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med 2017; 45 (06) 1061-1093
26
Kaur J,
Singhi P,
Singhi S,
Malhi P,
Saini AG.
Neurodevelopmental and behavioral outcomes in children with sepsis-associated encephalopathy admitted to pediatric intensive care unit: a prospective case control study. J Child Neurol 2016; 31 (06) 683-690
27
Daoud A,
Duff JP,
Joffe AR.
Alberta Sepsis Network.
Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review. Crit Care 2014; 18 (05) 489
28
Wolters AE,
Zaal IJ,
Veldhuijzen DS.
et al.
Anticholinergic medication use and transition to delirium in critically ill patients: a prospective cohort study. Crit Care Med 2015; 43 (09) 1846-1852
29
Mody K,
Kaur S,
Mauer EA.
et al.
Benzodiazepines and development of delirium in critically ill children: estimating the causal effect. Crit Care Med 2018; 46 (09) 1486-1491
