Delirium and Anxiety Outcomes Related to Visiting Policy Changes in the Intensive Care Unit During the COVID-19 Pandemic

Abstract

ObjectiveTo evaluate the effect of intensive care unit (ICU) visit on the incidence of delirium, delirium subtype, and anxiety level in ICU patients.MethodsTrained psychiatrists and nurses evaluated ICU patients for delirium, delirium subtypes, and anxiety. Propensity score matching (PSM) was used to retrospectively analyze the data. Then, we compared the differences in the incidence of delirium, delirium subtypes, and anxiety level before and after the ICU visit ban. Logistic regression was conducted to identify the risk factors for delirium subtypes and high anxiety levels.ResultsAfter PSM, there was no statistically significant difference in the incidence of delirium between the non-visiting and restrictive visiting groups (non-visiting 27.4% versus restrictive visiting 30.9%, p = 0.162). The proportion of hyperactive and mixed subtypes was higher in the non-visiting than in the restrictive visiting group (non-visiting 35.3 and 30.1% versus restrictive visiting 27.7 and 20.1%, p = 0.002). The anxiety level was higher in the non-visiting than in the restrictive visiting group (state-trait anxiety inventory score: non-visiting 53.46 ± 4.58 versus restrictive visiting 52.22 ± 6.50, p = 0.009). Patients who stayed in the ICU during the visit ban were more likely to have hyperactive (p = 0.005) and mixed subtype (p = 0.001) than those who did not. Moreover, patients who stayed in the ICU during the visit ban were more likely to experience high anxiety levels than those who did not (p < 0.001).ConclusionProhibition of ICU visits during COVID-19 pandemic did not affect the incidence of delirium during COVID-19 but could change the delirium subtype and raise anxiety level. Moreover, visiting prohibition was a risk factor for non-hypoactive delirium subtype and high anxiety levels. Therefore, ICU visits are important in dealing with delirium subtypes and anxiety in ICU patients.

Family caregivers’ responses to a visitation restriction policy at a Korean surgical intensive care unit before and during the coronavirus disease 2019 pandemic

“…While the causal association between the patient-family separation and adverse psychological outcomes of the caregivers needs further investigation, a study conducted in Turkey with 120 ICU family caregivers reported visitation restriction as an independent risk factor for worse depressive symptoms in caregivers [31] . In South Korea, the effects of visitation restrictions on the outcomes of patients or families have not yet been investigated fully, except for one study that reported visitation restriction as a risk factor for the non-hypoactive delirium subtype and worse anxiety symptoms in patients [13] .…”

“…Since February 2020, family visitation has been completely banned in most ICUs in South Korea, including our institution. While studies have examined how current family engagement efforts has been changed since COVID-19 pandemic [12] and effects of visitation restriction on delirium and anxiety among the ICU patients [13] , little is known about the quality of life, emotions, and perceptions toward the visitation policies among ICU family caregivers since the start of the COVID-19 pandemic in South Korea. In South Korea, flexible and open visitation was not a norm in ICU settings, which was different from other countries where family visits were more flexible and for longer durations.…”

Therapeutic Approaches to the Neurologic Manifestations of COVID-19

“…Studies have found that 30% to 51.8% of critically ill COVID-19 patients had at least one episode of hyperactive delirium, which is substantially higher than the pre-pandemic incidence of 12.7% in critically ill patients [50,54,55]. The reason behind this high rate of agitation in COVID-19 patients is unclear; this could be related to the greater severity of COVID-19 lung injury and higher levels of ventilatory support, the frequent use of prone positioning, a relatively higher incidence of young individuals needing critical care during early COVID-19 surges, crisis staffing with providers less experienced in effective sedation management, decreased family visitation, or perhaps biological mechanisms unique to SARS-CoV-2 infection [50,[55][56][57][58].…”

Delirium Na Unidade De Terapia Intensiva: Revisão Bibliográfica

“…O delirium consiste em um distúrbio agudo e flutuante 1-5 da cognição 1 e consciência 1,3 que cursa com desatenção [1][2][3][4][5] , confusão mental [1][2][3]5 ou alteração do nível de consciência 2,5 . Entre as manifestações clínicas estão agitação, delírios, alucinações e distúrbios do ciclo sonovigília 6 .…”

“…Nos pacientes hospitalizados, acredita-se que cerca de 30 a 40% dos casos de delirium ocorrem devido a presença de fatores de risco modificáveis 10. Entre os efeitos adversos proporcionados pelo delirium estão estadia hospitalar prolongada [1][2][3][4]6 , altos custos 3,4 , ventilação mecânica prolongada, declínio cognitivo após alta 4 , aumento de morbidade e mortalidade 1,3,4,6,7 intra e extra-hospitalares 4,7 . Estima-se que, anualmente, nos Estados Unidos, são gastos cerca de 10 bilhões de dólares com custos sociais e de saúde com o delirium 7 .…”