Abstract
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.
Highlights
The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in a global pandemic, with a significant and increasing disease burden in the United States.[1]
Since other coronaviruses have known neurotropism and the angiotensinconverting enzyme 2 (ACE2) receptor used by SARS-CoV-2 to invade host cells is expressed in neurons and glial cells of the CNS, there is potential for direct CNS invasion by the virus.[8,9,10]
2 patients admitted to an intensive care unit (ICU) for postoperative monitoring were excluded because they did not develop respiratory symptoms during their ICU stay, and 1 patient admitted with intracranial hemorrhage was excluded because he developed severe delirium prior to developing COVID-19-associated respiratory illness
Summary
The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in a global pandemic, with a significant and increasing disease burden in the United States.[1]. 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. 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. 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
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