Impact of Delirium on Pediatric Critical Care Outcomes and Management Strategies: A Systematic Review and Meta-Analysis.

BACKGROUND

Delirium in the pediatric intensive care units (PICUs) poses substantial challenges for nursing care and has a profound impact on key clinical metrics, including the period of assisted breathing support, total hospitalization time, and child survival rates. Effective nursing strategies are essential to improve patient prognosis and quality of life.

AIM: We perform a systematic review and meta-analysis to examine how delirium relates to clinical outcomes in PICU patients and to map out the corresponding nursing management strategies.

DESIGN

A systematic review and meta-analysis is conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

METHODS

Up to January 18, 2024, a comprehensive search of Cochrane Library, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted following the population, exposure, comparison, outcomes, and study design (PECOS) structure. Data were extracted with a standardized form, study quality was appraised using the Newcastle-Ottawa Scale, and analyses were carried out in STATA 17.0. The entire process complied with the PRISMA 2020 checklist.

RESULTS

Among 14 studies (6019 children), delirium significantly increased mechanical ventilation risk (odds ratio [OR] = 5.68, 95% confidence interval [CI]: 4.20-7.69, p < 0.01), prolonged intensive care unit (ICU) stay (standardized mean difference [SMD] = 0.61, 95% CI: 0.53-0.70, p < 0.01), and raised mortality (OR = 5.09, 95% CI: 1.81-14.32, p < 0.01). Limited data precluded meta-analysis of postdischarge quality of life. Neither the funnel plot nor Egger's test revealed significant publication bias.

CONCLUSIONS

Delirium is a key predictor of nursing-sensitive outcomes in pediatric ICU patients. Early screening and systematic nursing management (e.g., Cornell Assessment of Pediatric Delirium [CAPD] monitoring and family-centered rehabilitation) reduce risks and improve recovery and quality of life. Nurses are essential in delirium management by conducting regular assessments, optimizing the care environment, and facilitating teamwork across disciplines. Healthcare institutions should incorporate delirium management protocols into routine nursing workflows and standardize quality-of-life evaluations.