Delirium Is a Common Consequence of Severe COVID-19 – Cognitive Impairment Could Be Lasting

Cognitive impairment is very likely for patients in ICU and can be permanent.

More than a year into the COVID-19 pandemic, researchers are revealing the many devastating consequences that patients can face both during and after hospitalization.

A new study of nearly 150 patients hospitalized for COVID at the start of the pandemic found that 73% had delirium, a severe mental state disorder in which a patient is confused, agitated and unable to think clearly.

Patients with delirium tended to be sicker, with more co-morbidities such as hypertension and diabetes, and also appeared to have more severe COVID-related illness, said study author Phillip Vlisides, MD, of Michigan Medicine’s Department of Anesthesiology.

“COVID is also associated with a number of other adverse effects that prolong hospitalization and complicate recovery,” he added.

Using patient medical records and post-discharge telephone surveys for a group of patients admitted to intensive care between March and May 2020, the research team sought to identify the common thread among patients who developed delirium. Several factors are involved, says Vlisides.

The disease itself can lead to decreased oxygen to the brain, as well as the development of blood clots and stroke, resulting in cognitive impairment. In addition, inflammatory markers were highly elevated in patients with delirium. Confusion and excitement can be a result of inflammation of the brain.

What was worse, healthcare teams were often unable to perform standard delirium reduction techniques, such as exercises to get a patient moving or allowing visitors or objects from home to orient patients while they are in the hospital. goods.

Vlisides said: “In the beginning of the pandemic, we did not implement standard delirium prevention protocols as we usually do. A major reason for this is that early in the pandemic in the pre-vaccination era, we had limited personal protective equipment and tried to limit exposure to COVID and the transmission of diseases.”

Furthermore, there was an association between the use of sedatives and delirium: patients with delirium were sedated more often and more frequently at higher doses. “It is common to use IV sedatives in the ICU, especially for patients who are on a ventilator. However, by talking to nurses, we found that patients with severe COVID were inherently more delirious and agitated at baseline, perhaps leading to increased sedative use.”

The study also found that cognitive impairment can persist even after discharge. Nearly a third of patients had not marked delirium as resolved on their chart when they left the hospital, and 40% of these patients required skilled nursing care. Nearly a quarter of patients screened positive for delirium based on their caregiver’s assessment. In some patients, these symptoms lasted for months. This can make managing the recovery process after hospitalization much more difficult.

“A family member who is confused has a limited ability to care for themselves and needs extra care support, which is certainly a big challenge.”

Vlisides recognizes that healthcare teams are doing their best with the resources they have, especially as hospitals continue to fill up with patients with COVID.

“Whatever creative ways we can implement delirium prevention protocols are likely to be very helpful,” he said. “That includes consistent communication with family members, bringing in photos and objects from home, and video visits if family can’t visit safely.”

And for family and other caregivers struggling to care for loved ones, he urges them to get help from their primary care physician as soon as possible.

The message is that for patients hospitalized with severe COVID-19, cognitive impairment — including depression and delirium — is very likely, he added.

“Overall, this study highlights another reason why it is so important to get vaccinated and prevent serious illness. There can be neurological complications in the long term that we may not talk about as much as we should.”

In addition to Vlisides, the study authors were: Jacqueline Ragheb, Amy McKinney, Mackenzie Zierau, Joseph Brooks, Maria Hill-Caruthers, Mina Iskander, Yusuf Ahmed, Remy Lobo and Graciela Mentz.

Reference: “Delirium and Neuropsychological Outcomes in Critically Ill Patients with COVID-19: A Cohort Study” by Jacqueline Ragheb, Amy McKinney, Mackenzie Zierau, Joseph Brooks, Maria Hill-Caruthers, Mina Iskander, Yusuf Ahmed, Remy Lobo, Graciela Mentz, and Phillip E Vlisides, September 17, 2021, BMJ Open.
DOI: 10.1136/bmjopen-2021-050045