Delirium and Neuropsychological Outcomes in Critically Ill Patients with COVID-19: an Institutional Case Series
Abstract
Objective
To characterize the clinical course of delirium for COVID-19 patients in the intensive care unit, including post-discharge cognitive outcomes.
Patients and Methods
A retrospective chart review was conducted for patients diagnosed with COVID-19 (n=148) admitted to an intensive care unit at Michigan Medicine between March 1, 2020 and May 31, 2020. A validated chart review method was used to identify presence of delirium, and various measures (e.g., Family Confusion Assessment Method, Short Blessed Test, Patient-Health Questionnaire-9) were used to determine neuropsychological outcomes between 1-2 months after hospital discharge.
Results
Delirium was identified in 108/148 (73%) patients in the study cohort, with median (interquartile range) duration lasting 10 (4 – 17) days. In the delirium cohort, 50% (54/108) of patients were African American, and delirious patients were more likely to be female (76/108, 70%) (absolute standardized differences >.30). Sedation regimens, inflammation, deviation from delirium prevention protocols, and hypoxic-ischemic injury were likely contributing factors, and the most common disposition for delirious patients was a skilled care facility (41/108, 38%). Among patients who were delirious during hospitalization, 4/17 (24%) later screened positive for delirium at home based on caretaker assessment, 5/22 (23%) demonstrated signs of questionable cognitive impairment or cognitive impairment consistent with dementia, and 3/25 (12%) screened positive for depression within two months after discharge.
Conclusion
Patients with COVID-19 commonly experience a prolonged course of delirium in the intensive care unit, likely with multiple contributing factors. Furthermore, neuropsychological impairment may persist after discharge.
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