Children: memories

CHILDREN'S MEMORIES OF PICU

Background

There are a small number of studies examining what children remember about PICU1. The majority remember something about their admission but their memories are frequently quite neutral2 . 

There are reports of nightmares and hallucinations in adults in intensive care and a recent study suggests that children may report more hallucinations than adults when assessed using formal psychiatric criteria for assessing delirium3.Furthermore, delusional memory in adult patients has been shown to be associated with subsequent posttraumatic stress4.

Research to date
In a study following up 102 children aged 7-17 years, 3 months after admission5.

  • 63% of children had some factual recall of PICU
  • One in three children reported delusional memories, including hallucinations, associated with their PICU admission
  • These were similar in nature (disturbing, threatening, primarily visual) to those reported by adults after intensive care
  • Report of delusional memory was significantly related to duration of sedation
  • Report of delusional memory was also significantly associated with higher post traumatic stress score whereas factual memory of admission was not

Ideas for future work:

  • This study was retrospective and cross sectional. A prospective study replicating relationship between hallucinations would make the case for a causal relationship stronger
  • More development work is needed to adapt current ICU specific delirium measures and withdrawal measures used with adults for use with children. A particular challenge will be to find a way to assess these phenomena in the high proportion of very young nonverbal children
  • Theoretically there is a lot of scope, (either using presence of delusional memory or measure of delirium as outcome), to examine whether different types of sedation or different weaning protocols reduce incidence of delusional memory/delirium6

NB delusional memory = presence of nightmare; dream; hallucination or feeling of being persecuted (definition from ICU Memory tool Jones et al (2000)).

References

  1. Colville G (2008)
  2. Playfor et al (2000)
  3. Leentjens et al (2008)
  4. Jones et al (2001)
  5. Colville et al (2008)  (See also 'Children’s factual and delusional memories of PICU'  presented at 36th SCCM Conference, Florida US, Feb 2007 ppt/ handout )
  6. See website on assessing delirium in adult ICU patients www.icudelirium.org
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