Delirium Incidence, Duration, and Severity in Critically Ill Patients With Coronavirus Disease 2019

Abstract

Objectives: To determine delirium occurrence rate, duration, and severity in patients admitted to the ICU with coronavirus disease 2019. Design: Retrospective data extraction study from March 1, 2020, to June 7, 2020. Delirium outcomes were assessed for up to the first 14 days in ICU. Setting: Two large, academic centers serving the state of Indiana. Patients: Consecutive patients admitted to the ICU with positive severe acute respiratory syndrome coronavirus 2 nasopharyngeal swab polymerase chain reaction test from March 1, 2020, to June 7, 2020, were included. Individuals younger than 18 years of age, without any delirium assessments, or without discharge disposition were excluded. Measurements and Main Results: Primary outcomes were delirium rates and duration, and the secondary outcome was delirium severity. Two-hundred sixty-eight consecutive patients were included in the analysis with a mean age of 58.4 years (sd, 15.6 yr), 40.3% were female, 44.4% African American, 20.7% Hispanic, and a median Acute Physiology and Chronic Health Evaluation II score of 18 (interquartile range, 13–25). Delirium without coma occurred in 29.1% of patients, delirium prior to coma in 27.9%, and delirium after coma in 23.1%. The first Confusion Assessment Method for the ICU assessment was positive for delirium in 61.9%. Hypoactive delirium was the most common subtype (87.4%). By day 14, the median number of delirium/coma-free were 5 days (interquartile range, 4–11 d), and median Confusion Assessment Method for the ICU-7 score was 6.5 (interquartile range, 5–7) indicating severe delirium. Benzodiazepines were ordered for 78.4% of patients in the cohort. Mechanical ventilation was associated with greater odds of developing delirium (odds ratio, 5.0; 95% CI, 1.1–22.2; p = 0.033) even after adjusting for sedative medications. There were no between-group differences in mortality. Conclusions: Delirium without coma occurred in 29.1% of patients admitted to the ICU. Delirium persisted for a median of 5 days and was severe. Mechanical ventilation was significantly associated with odds of delirium even after adjustment for sedatives. Clinical attention to manage delirium duration and severity, and deeper understanding of the virus’ neurologic effects is needed for patients with coronavirus disease 2019.

Consensus for the management of analgesia, sedation and delirium in adults with COVID-19-associated acute respiratory distress syndrome

“…and precipitating factors (which can be classified into 3 domains: disease severity, exposure to medications and environmental factors), it is likely that this increase in prevalence of delirium is not a product of a specific brain tropism of the virus but rather a massive burden of precipitating factors (regarding sedation, immobility, isolation, etc.). ( 81 , 83 ) The concept of eCASH proposed by Vincent et al is a good starting point for discussing nonpharmacological treatment measures. ( 54 ) Comfort as a first need, adequate analgesia, minimal sedation and humanized care focused on the patient and family are the axes of this new paradigm for intensive medicine.…”

Delirium in Covid-19 patients: Incidence, Risk Factors and Early Outcomes.

“…Previous studies that have measured delirium in COVID-19 have reported higher frequencies, mainly due to difference in patient selection (12,24) since they included only ICU patients. Severity of COVID-19, evidenced by higher NEWS2 score and the need of ICU hospitalization, is associated to higher incidence of delirium, as reported before (24). In our patients, delirium was associated with older age, as described in previous studies in critically-ill patients, either with COVID-19 (25) or in other settings (26,27).…”

Delirium in Covid-19 Patients: Incidence, Risk Factors and Early Outcomes.

“…Previous studies that have measured delirium in COVID-19 have reported higher frequencies, mainly due to difference in patient selection (12,24) since they included only ICU patients. Severity of COVID-19, evidenced by higher NEWS2 score and the need of ICU hospitalization, is associated to higher incidence of delirium, as reported before (24).…”

“…Previous studies that have measured delirium in COVID-19 have reported higher frequencies, mainly due to difference in patient selection (12,24) since they included only ICU patients. Severity of COVID-19, evidenced by higher NEWS2 score and the need of ICU hospitalization, is associated to higher incidence of delirium, as reported before (24). In our patients, delirium was associated with older age, as described in previous studies in critically-ill patients, either with COVID-19 (25) or in other settings (26,27).…”