Delirium Incidence, Duration and Severity in Critically Ill Patients with COVID-19

Abstract

Background Delirium incidence, duration and severity in patients admitted to the intensive care unit (ICU) due to COVID-19 is not known. Methods We conducted an observational study at two large urban academic Level 1 trauma centers. Consecutive patients admitted to the ICU with a positive SARS-CoV-2 nasopharyngeal swab polymerase chain reaction test from March 1st, 2020 to April 27, 2020 were included. Individuals younger than 18 years of age, without any documented delirium assessments (CAM-ICU), or without a discharge disposition were excluded. The primary outcomes were delirium rates and delirium duration and the secondary outcome was delirium severity. Outcomes were assessed for up to the first 14 days of ICU stay. Results Of 243 consecutive patients with confirmed COVID-19 admitted to the ICU, 144 met eligibility criteria and were included in the analysis. Delirium occurred in 73.6% (106/144) and delirium or coma occurred in 76.4% (110/144). Sixty-three percent of patients were positive for delirium on the first CAM-ICU assessment. The median duration of delirium and coma was 7 days (IQR: 3-10), and the median delirium duration was 5 days (IQR: 2-7). The median CAM-ICU-7 score was 6 (IQR: 4-7) representing severe delirium. Mechanical ventilation was associated with greater odds of developing delirium (OR: 42.1, 95%CI: 13.0-137.1). Mortality was 26.4% in patients with delirium compared to 15.8% in patients without delirium. Conclusions 73.6% of patients admitted to the ICU with COVID-19 experience delirium that persists for approximately 1 week. Invasive mechanical ventilation is significantly associated with odds of delirium. Clinical attention to prevent and manage delirium and reduce delirium duration and severity is urgently needed for patients with COVID-19.

Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients

“…The most frequent complication was delirium (36.70%), followed by coma, critical illness neuropathy, ischemic stroke, stupor, encephalopathy, seizures, cognitive deficit, and depression. The frequency of delirium is in line with current COVID-19 literature, in which it has ranged from 26.80 to 73.60% (34,36). Delirium was identified both in the acute and in the post-ICU phases during the severe acute respiratory syndrome (SARS) and Middle-East respiratory syndrome (MERS) epidemics, with a possible detrimental effect on length of stay (37).…”

“…A forest plot and a rank-hazard plot were provided for multivariate Cox regression. The rank-hazard plot is able to visualize the relationship between the relative hazard of variables entered in the multivariate Cox regression model(34). Logistic regression was performed to assess the risk factors associated with neurological complications.…”

Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically ill COVID-19 Patients

“…The most frequent complication was delirium (36.70%), followed by coma, critical illness neuropathy, ischemic stroke, stupor, encephalopathy, seizures, cognitive de cit, and depression. The frequency of delirium is in line with current COVID-19 literature, in which it has ranged from 26.80-73.60% (36,37). Delirium was identi ed both in the acute and in the post-ICU phases during the severe acute respiratory syndrome (SARS) and Middle-East respiratory syndrome (MERS) epidemics, with a possible detrimental effect on length of stay (38).…”

“…A forest plot and a rank-hazard plot were provided for multivariate regression. The rank-hazard plot is able to visualize the relationship between the relative hazard of variables entered in a multivariate Cox regression model [37]. Logistic regression was performed to assess the risk factors associated with neurological complications.…”

Short-term Outcomes for Patients and Providers After Elective Tracheostomy in COVID-19–Positive Patients

“…As previous studies have shown, COVID-19 patients have an estimated delirium prevalence rate of 73.6%. 20 Future studies should investigate underlying factors for the disproportionately higher number of cases and more severe cases of COVID-19 observed in ethnic minority groups.…”