New Risk for Covid-19 Patients: Delirium

Delirium is prevalent among older emergency department (ED) patients. It is associated with high morbidity and death and goes unrecognized. Anecdotal evidence has reported atypical presentations of coronavirus disease 2019 (COVID-19) in old adults; however, the amount of and outcomes related to delirium in older ED patients with COVID-19 infection haven’t been well defined.

According to findings from a study, COVID-19 victims admitted to the ICU within the initial months of the pandemic had a bigger burden of delirium and coma than patients with acute respiratory breakdown.

Researchers tracked the amount of delirium and coma in COVID-19 patients admitted to the ICU before April 28, 2020. Patients in over 14 countries were involved. 82% of the victims within the study were comatose for a median of 10 days, while 55% were delirious for a median of three days. Acute brain dysfunction lasted for a median of 12 days.

Background

We are amid an epidemic affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—the causative agent of COVID-19—as reported by the World Health Organization (WHO) in March 2020. The pandemic has affected over 50 million people globally, which has resulted in over 1.25 million deaths. In addition, millions of individuals with the infection have developed critical COVID-19, necessitating hospitalization and even intensive care treatment.

Neurological complexities of COVID-19

COVID-19 has causes several neurological symptoms and complications like encephalopathy (inflammation of the brain), delirium, strokes, seizures, and abnormal movements known as ataxia.

One of the foremost frequent complexities of severe COVID-19 is delirium, as explained by the researchers. As a result, 65 to 80 percent of these patients needed medical care unit (ICU) hospitalization. Virus’ attack on the central nervous system and associated inflammatory responses cause cognitive loss. In addition, the risks are increased thanks to related factors like social isolation and sedation during ICU stay.

Questions about delirium

Despite such a high number of deliriums among patients with severe COVID-19, this condition’s actual clinical course isn’t clearly understood. The authors of this study consider several contributing factors like the utilization of multiple medications, associated inflammation, strokes, and vascular cases within the brain. They write that these parts need to be noted in their contribution to neurological effects in severe COVID-19.

Some of the prevention procedures of delirium among the patients are:

Assess and treat pain. Discontinue physical restraints—routine exercises. Promote the use of visual and hearing aids—sleep promotion protocols (e.g., lights off in the dark, melatonin tablets). Spontaneous awakening trials.

Findings

Most of the patients showed delirium and neuropsychological impairments after severe COVID-19. In addition, they commonly had problems like hypertension, DM, and obesity. Overall results of this study were that Delirium incidence was seen among 107 of the entire 148 patients (72 percent). The maximum duration of delirium was 10-15 days ranging between 4 and 17 days.

The most usual delirium prevention measure was assessment and treatment for pain; a minuscule amount commonly used provided objects amicable to the patient and using unconstrained awakening trials.

The use of new antidepressant grew among those with delirium (24 percent patients or 26 among 107 patients) in contrast to those without delirium (4 out of 41 or 9.8 percent)

Psychiatry consultation was necessitated by 20 percent of those with delirium and 0 percent among those without delirium. Improvement in agitation wasn’t seen among any patients during their hospital stay. The median duration of hospital stay was 25 days, and the median duration of ICU stay was 15 days. Length of hospitalization, ICU stay and wish for mechanical ventilation lengthened the period of delirium in patients. These delirium patients had high markers for inflammation like WBC, CRP, LDH.

The final disposition of 39 percent of delirium patients was a skillful care facility after discharge. Twenty-four percent of patients had cognitive impairment after their discharge from the hospital. Meanwhile, 12 percent of patients with delirium tested positive for depression after release.

Outcomes and suggestions

The study’s researchers recommend that delirium may be a dangerous and customary complexity seen amidst those with severe COVID-19. This was likely to be extended, especially with an extended ICU stay.