Time trends of delirium rates in the intensive care unit

Khan, Sikandar; Lindroth, Heidi; Hendrie, Kyle; Wang, Sophia; Imran, Sundus; Perkins, Anthony J.; Gao, Sujuan; Vahidy, Farhaan S; Boustani, Malaz; Khan, Babar

doi:10.1016/j.hrtlng.2020.03.006

Cited by 15 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is some evidence that the incidence of ICU delirium is decreasing in recent years, as more centers adopt protocolized delirium monitoring and evidence-based interventions, such as limiting the use of benzodiazepines. 39 However, the COVID-19 pandemic has strained ICU resources across the United States, and legitimate concerns that COVID-19 may be associated with a particularly high frequency of delirium have been raised. In this regard, it is reassuring that the frequency of delirium in this study is lower than prominent historical cohorts.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Predictors and Outcomes of Delirium in Critically Ill Patients With COVID-19

Williamson

Faiver

Nguyen

et al. 2021

The Neurohospitalist

View full text Add to dashboard Cite

Background and Purpose: A variety of neurological manifestations have been attributed to COVID-19, but there is currently limited evidence regarding risk factors and outcomes for delirium in critically ill patients with COVID-19. The purpose of this study was to identify delirium in a large cohort of ICU patients with COVID-19, and to identify associated features and clinical outcomes at the time of hospital discharge. Methods: This is an observational cohort study of 213 consecutive patients admitted to an ICU for COVID-19 respiratory illness. Delirium was diagnosed by trained abstractors using the CHART-DEL instrument. The associations between key clinical features, sedation and delirium were examined, as were the impacts of delirium on clinical outcomes. Results: Delirium was identified in 57.3% of subjects. Delirious patients were more likely to receive mechanical ventilation, had lower P: F ratios, higher rates of renal replacement therapy and ECMO, and were more likely to receive enteral benzodiazepines. Only mechanical ventilation remained a significant predictor of delirium in a logistic regression model. Mortality was not significantly different, but delirious patients experienced greater mechanical ventilation duration, ICU/hospital lengths of stay, worse functional outcomes at discharge, and were less likely to be discharged home. Conclusions: Delirium is common in critically ill patients with COVID-19 and appears to be associated with greater disease severity. When present, delirium is associated with worse functional status at discharge, but not increased mortality. Additional studies are necessary to determine the generalizability of these results and the impact of delirium on longer-term cognitive and functional outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence, Predictors and Outcomes of Delirium in Critically Ill Patients With COVID-19

Williamson

Faiver

Nguyen

et al. 2021

The Neurohospitalist

View full text Add to dashboard Cite

show abstract

“…Reductions in the prevalence of ICU delirium from a historical high of 80% to rates of 16.5-33% have been reported over the past two years. 13,16,17,19 These reductions CoV-2 has been identified in cerebrospinal fluid as well as brain tissue, the neurotoxic impact of COVID-19 is increasingly plausible. [31][32][33]35 The possible pathways for neuronal damage due to COVID-19 require additional study.…”

Section: Discussionmentioning

confidence: 99%

“…Reductions in the prevalence of ICU delirium from a historical high of 80% to rates of 16.5–33% have been reported over the past two years. 13,16,17,19 These reductions were likely linked to the implementation of the Society of Critical Care Medicine’s PADIS guidelines, multi-disciplinary bundled protocols for delirium prevention (ABCDEF), avoidance of deliriogenic agents, increasing use of non-invasive ventilation strategies and heated high-flow nasal cannula devices leading to reduced rates of invasive ventilation, and increasing clinician awareness regarding the harms of delirium. 17,28–30 The COVID-19 crisis has seriously challenged these care improvements as pre-established multi-disciplinary care models of ICU care become disrupted and health systems are overwhelmed with critically ill patients requiring invasive mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] Prior to COVID-19, the prevalence of delirium in mechanically ventilated patients has been decreasing from a historically high rate of 80% to a range of 16.5-33%. [13][14][15][16][17][18][19] In the setting of the current global health crisis, hospital resources have been stretched to their limits to meet the needs of a large number of critically ill patients. The unintended impact of limited resources on clinical practice has raised concerns that current ICU delirium rates have returned to the historically high levels.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Khan

Lindroth

Perkins

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…In a French study, 84% of the intensive care SARS-CoV-2 infected patients exhibited neurological symptoms and 79% exhibited delirium or acute encephalopathy [ 157 ]. In contrast, others reported only 16.5% [ 158 ]). The high occurrence of delirium reported by Helms and co-workers was attributed to the acute SARS-CoV-2 infected patients that had been admitted for acute respiratory distress syndrome (ARDS).…”

Section: Risk Factors For Pdmentioning

confidence: 99%

The Nigral Coup in Parkinson’s Disease by α-Synuclein and Its Associated Rebels

Sian-Hülsmann

Riederer

2021

Cells

View full text Add to dashboard Cite

The risk of Parkinson’s disease increases with age. However, the etiology of the illness remains obscure. It appears highly likely that the neurodegenerative processes involve an array of elements that influence each other. In addition, genetic, endogenous, or exogenous toxins need to be considered as viable partners to the cellular degeneration. There is compelling evidence that indicate the key involvement of modified α-synuclein (Lewy bodies) at the very core of the pathogenesis of the disease. The accumulation of misfolded α-synuclein may be a consequence of some genetic defect or/and a failure of the protein clearance system. Importantly, α-synuclein pathology appears to be a common denominator for many cellular deleterious events such as oxidative stress, mitochondrial dysfunction, dopamine synaptic dysregulation, iron dyshomeostasis, and neuroinflammation. These factors probably employ a common apoptotic/or autophagic route in the final stages to execute cell death. The misfolded α-synuclein inclusions skillfully trigger or navigate these processes and thus amplify the dopamine neuron fatalities. Although the process of neuroinflammation may represent a secondary event, nevertheless, it executes a fundamental role in neurodegeneration. Some viral infections produce parkinsonism and exhibit similar characteristic neuropathological changes such as a modest brain dopamine deficit and α-synuclein pathology. Thus, viral infections may heighten the risk of developing PD. Alternatively, α-synuclein pathology may induce a dysfunctional immune system. Thus, sporadic Parkinson’s disease is caused by multifactorial trigger factors and metabolic disturbances, which need to be considered for the development of potential drugs in the disorder.

show abstract

Time trends of delirium rates in the intensive care unit

Cited by 15 publications

References 24 publications

Incidence, Predictors and Outcomes of Delirium in Critically Ill Patients With COVID-19

Incidence, Predictors and Outcomes of Delirium in Critically Ill Patients With COVID-19

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

The Nigral Coup in Parkinson’s Disease by α-Synuclein and Its Associated Rebels

Contact Info

Product

Resources

About