Icu-Acquired Delirium in Covid Year of 2021 and Its Outcomes: A Retrospective Study

ABSTRACT

INTRODUCTION: ICU-acquired delirium results in increased LOS, duration of mechanical ventilation, and mortality. Patients with COVID are at increased risk. Current literature suggests that delirium without coma occurs in at least about 30 % of COVID patients admitted to ICU. In our ICU we use an EPIC EMR-based daily ICU checklist with ABCDEF bundle during our rounds and utilized virtual ICU during the daytime in addition to the nights with peak surges. With our study, we wanted to evaluate the incidence of Delirium during our COVID year of 2021 and its relation to Mortality rate and ICU Length of stay (LOS). METHOD(S) A retrospective evaluation of patients admitted to Houston Methodist Baytown ICU from January to December 2021. Patients with covid positive were included. Data were obtained from the EPIC and ICU dashboard. Compliance with the ABCDEF ICU checklist was reviewed by auditing 20 patient charts per month. Delirium screening compliance was evaluated on AM and PM shifts for all ICU patients. Hospital ICU acquired delirium % was defined as all patients discharged from the ICU unit in that month that didn't have a positive CAM-ICU in the first 48 hrs. and then had a positive CAM-ICU after 48 hrs. in the ICU. ICU Mortality rate is defined as the percentage of patients with ICU stays who expired during ICU stay. Descriptive statistics and linear regression were used to compare and correlate. RESULT(S) In 2021, we had 377 ICU patients with COVID positive, an Average CMI of 4.986, and a LOS index of 1.24. Compliance with the daily ABCDEF ICU Checklist was 98%. Compliance to am screening was 89.41% vs. pm screening 90.56%. Mean Incidence of ICU acquired Delirium in COVID patients was only 7.14 % (2.77- 15.22) with peaks occurring during COVID surges. Linear regression analysis predicted a strong direct relationship between Delirium % and ICU Mortality rate (P< 0.05), and ICU Length of Stay(P< 0.05). CONCLUSION(S) Our data from 2021 shows Delirium % that is significantly less than the incidence. The lower % might have been from continuing to adhere to the ABCDEF bundle, utilization of the ICU checklist, and effective use of virtual ICU. Hospital ICU acquired delirium % correlated with ICU mortality and ICU length of stay. Hence, it is important to continue to focus on ways to decrease ICU delirium.