Abstract P-482: INCIDENCE AND AGREEMENT OF IATROGENIC WITHDRAWAL SYNDROME AND HYPERACTIVE DELIRIUM AFTER PEDIATRIC HEART SURGERY PATIENTS

Abstract

Aims & Objectives: The risk factors and behavioral symptoms for iatrogenic withdrawal syndrome (IWS) have been already reported and well known that they were similar with risk factors of hyperactive delirium in pediatric patients. However, very few clinical studies have evaluated the delirium and IWS concurrently. We think that IWS is associated, and manifests concurrently, with hyperactive delirium (HD). Thus, we sought to examine their symptom incidence and agreement. Methods Patients who underwent surgery for congenital heart diseases in a single Japanese pediatric intensive care unit were entered in this study. #8232;Daily delirium and IWS assessed using the Cornell Assessment of Pediatric Delirium (CAPD) and the Withdrawal Assessment Tool-1. RASS score ≥ + 1 and CAPD score ≥ 9 were defined as HD. Patients were assessed for IWS from the first day of weaning from opioid or benzodiazepines until 72 h after the disconnection. We used the bootstrap method to measure the κ statistic value for daily delirium and IWS. Results A total of 245 paired delirium and IWS assessments were completed for 38 patients with a median age of 23 months [interquartile range (IQR), 1–36] and a median PRISM III score of 13 (IQR, 10–16), with 87% patients of whom required mechanical ventilation. The prevalence of delirium, HD and IWS were 33% (80/245), 6.9% (17/245), and 7.8% (19/245), respectively. The 95% confidence interval of the κ statistic value for HD and IWS was 35–76. Conclusions The symptom incidence of HD and IWS exhibited poor to good agreement; they do not necessarily develop concurrently.