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Delirium Incidence, Duration, and Severity in Critically Ill Patients With Coronavirus Disease 2019.
Khan, Sikandar H; Lindroth, Heidi; Perkins, Anthony J; Jamil, Yasser; Wang, Sophia; Roberts, Scott; Farber, Mark; Rahman, Omar; Gao, Sujuan; Marcantonio, Edward R; Boustani, Malaz; Machado, Roberto; Khan, Babar A.
  • Khan SH; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
  • Lindroth H; IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN.
  • Perkins AJ; Indiana University Center of Health Innovation and Implementation Science, Indianapolis, IN.
  • Jamil Y; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
  • Wang S; IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN.
  • Roberts S; Indiana University Center of Health Innovation and Implementation Science, Indianapolis, IN.
  • Farber M; Indiana University School of Nursing, Indianapolis, IN.
  • Rahman O; Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
  • Gao S; Lebanese American University, Beirut, Lebanon.
  • Marcantonio ER; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
  • Boustani M; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
  • Machado R; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
  • Khan BA; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Crit Care Explor ; 2(12): e0290, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-949452
ABSTRACT

OBJECTIVES:

To determine delirium occurrence rate, duration, and severity in patients admitted to the ICU with coronavirus disease 2019.

DESIGN:

Retrospective data extraction study from March 1, 2020, to June 7, 2020. Delirium outcomes were assessed for up to the first 14 days in ICU.

SETTING:

Two large, academic centers serving the state of Indiana. PATIENTS Consecutive patients admitted to the ICU with positive severe acute respiratory syndrome coronavirus 2 nasopharyngeal swab polymerase chain reaction test from March 1, 2020, to June 7, 2020, were included. Individuals younger than 18 years of age, without any delirium assessments, or without discharge disposition were excluded. MEASUREMENTS AND MAIN

RESULTS:

Primary outcomes were delirium rates and duration, and the secondary outcome was delirium severity. Two-hundred sixty-eight consecutive patients were included in the analysis with a mean age of 58.4 years (sd, 15.6 yr), 40.3% were female, 44.4% African American, 20.7% Hispanic, and a median Acute Physiology and Chronic Health Evaluation II score of 18 (interquartile range, 13-25). Delirium without coma occurred in 29.1% of patients, delirium prior to coma in 27.9%, and delirium after coma in 23.1%. The first Confusion Assessment Method for the ICU assessment was positive for delirium in 61.9%. Hypoactive delirium was the most common subtype (87.4%). By day 14, the median number of delirium/coma-free were 5 days (interquartile range, 4-11 d), and median Confusion Assessment Method for the ICU-7 score was 6.5 (interquartile range, 5-7) indicating severe delirium. Benzodiazepines were ordered for 78.4% of patients in the cohort. Mechanical ventilation was associated with greater odds of developing delirium (odds ratio, 5.0; 95% CI, 1.1-22.2; p = 0.033) even after adjusting for sedative medications. There were no between-group differences in mortality.

CONCLUSIONS:

Delirium without coma occurred in 29.1% of patients admitted to the ICU. Delirium persisted for a median of 5 days and was severe. Mechanical ventilation was significantly associated with odds of delirium even after adjustment for sedatives. Clinical attention to manage delirium duration and severity, and deeper understanding of the virus' neurologic effects is needed for patients with coronavirus disease 2019.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Reviews Language: English Journal: Crit Care Explor Year: 2020 Document Type: Article Affiliation country: CCE.0000000000000290

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Reviews Language: English Journal: Crit Care Explor Year: 2020 Document Type: Article Affiliation country: CCE.0000000000000290