Publicado
Delirio en niños críticamente enfermos
Delirium in critically ill children
DOI:
https://doi.org/10.15446/revfacmed.v68n4.77430Palabras clave:
Delirio, Cuidados Críticos, Pediatría, Trastornos neurocognitivos (es)Delirium, Critical Care, Pediatrics, Neurocognitive Disorders (en)
El delirio en pacientes críticos es una condición médica que afecta tanto a adultos como a niños; en ambas poblaciones implica graves complicaciones como estancia hospitalaria prolongada, alto riesgo de muerte y deterioro cognitivo a largo plazo, así como mayores costos económicos en cuanto a la prestación de servicios de salud. La principal dificultad de esta condición en la población pediátrica es su adecuado reconocimiento, ya que puede presentarse en edades muy tempranas, incluso en niños lactantes, cuando sus signos y síntomas pueden confundirse o superponerse con otras patologías, tales como el síndrome de abstinencia. En consecuencia, en estos casos el uso de herramientas diagnósticas puede ser una labor compleja que implica múltiples dificultades.
Antes de 2011 no había muchos estudios que abordaran la evaluación del delirio en niños. Sin embargo, ese mismo año se estableció la primera escala desarrollada específicamente para el monitoreo de pacientes en unidades de cuidado intensivo pediátrico, lo que llevó a un aumento significativo del número de casos de delirio en niños menores de 5 años críticamente enfermos; esta situación hizo que los pediatras se interesaran más en estudiar esta importante patología.
La presente reflexión, basada en una revisión de la literatura, busca actualizar el amplio espectro fisiopatológico del delirio en niños críticamente enfermos y, de esta forma, mejorar su tamizaje, diagnóstico e intervenciones terapéuticas tempranas en todas las edades pediátricas, incluso en menores de 5 años.
Delirium in critically ill patients is a medical condition that affects adults and children alike and has serious consequences for both populations, including prolonged hospital stay, high risk of death, long-term cognitive impairment, as well as increased health care costs. In the pediatric population, the main complication of this condition lies in its difficult recognition given that it can occur at very early ages, even in infants, when its signs and symptoms can be confused or overlapped with other pathologies such as withdrawal syndrome. Consequently, diagnostic tools may be more difficult to implement and use in these cases.
Studies on delirium in children were scarce until 2011, when the first scale designed specifically for monitoring patients in pediatric intensive care units was developed. Thanks to this scale, the number of delirium cases in critically ill children under 5 years of age significantly increased, which in turn, made pediatricians to be more interested in studying this important pathology.
This reflection paper, based on a literature review, seeks to update the broad physiopathological spectrum of delirium in critically ill children and thus improve their screening, diagnosis and early treatment in all pediatric age groups, even in patients under 5 years of age.
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