Emerging research shows that patients with COVID-19 who are admitted to an intensive care unit are more likely to suffer from persistent delirium.
The medical term for confusion and decreased awareness of the surroundings is called Delirium. It is common in hospitalized patients.
It turns out that severe cases of COVID-19 can trigger something similar. Initial investigations suggest that COVID-19-related delirium can occur in as high as 80 percent of COVID-19 patients admitted to intensive care. This could be due to a loss of oxygen or inflammation.
A new analysis of COVID-19 patients in critical condition at one Michigan hospital has shown that delirium is an extremely common symptom. It could slow down patient recovery if not addressed.
Researchers used medical records and discharge surveys of 148 patients who were admitted to the ICU from March through May 2020 to determine that more than 70% of them experienced a persistent disturbance in their mental abilities.
The delirium could last for several days in most cases. Nearly a third of the participants were unable to show that they had fully recovered from the delirium.
Nearly half of those discharged from hospital with cognitive impairment required skilled nursing care in order to live at home. According to phone surveys that were conducted over the period of one to two months after being discharged, their persistent confusion affected their ability to care for themselves.
The authors conclude that these results are consistent with prior data that showed a high rate of delirium among critically ill patients who were treated with COVID-19.
"Moreover, the median time of delirium (ten days) is longer than in other critically ill patients."
It is not clear if these severe impairments are caused by the SARS-CoV-2 viruses, which can cause a strange number of neurological symptoms that can last for up to six months, or if they are more generalized signs of critical illness.
Cognitive impairment is generally seen in around 20 percent of acute care patients. It's therefore expected that it will occur to some extent. However, the current pandemic appears to have at most tripled this number.
Although the cause of COVID-19 delirium is still unknown, Michigan researchers have found that ICU patients infected by the coronavirus experience a "considerable neuropsychological burden" during and after discharge.
Phillip Vlisides, an anesthesiologist at Michigan Medicine, said that "Overall this study highlights another reason why getting vaccined and preventing severe illnesses is so important."
"Long-term neurological complications can occur that we may not talk about as often as we should.
For example, early in the pandemic, it was uncommon to check patients for signs of delirium.
Even though delirium was evident, exercise regimens and other innovative strategies to improve cognitive performance, such as face-to-face family time or breathing trials, were not often introduced. This may have been because protective equipment wasn't readily available at that time.
Many patients suffering from severe COVID-19 cases were discharged from hospital without being properly treated.
This is a serious problem. Delirium can be associated with long hospitalizations and recovery from illness.
For example, the Michigan study found that patients suffering from delirium stayed longer in the ICU and hospital. They also relied more heavily on mechanical ventilation.
Vlisides says, "Any creative way we can implement delirium prevention protocol is likely to prove very helpful."
"This includes constant communication with family members, bringing pictures and objects from home, as well as video visits to family members if they are unable to visit.
It turns out that patients who are more vulnerable to severe forms COVID-19 (e.g., from racial or ethnic minorities) are more likely to experience delirium in hospital.
Researchers in Michigan discovered that half of the patients in the delirium treatment group were African Americans, a shocking sign of the ongoing disparities in healthcare in America.
We will need to continue our research in more acute care facilities as well as among larger and more diverse groups before we can determine with any certainty who is most likely to experience delirium while being hospitalized with COVID-19.
Michigan's study found that female patients were more likely to be in the delirium group than their male counterparts. However, initial research suggests that ICU patients who are male are more vulnerable to cognitive impairment.
If delirium is a real symptom of severe COVID-19, it is important to begin to treat and recognize the signs as soon as possible. It could be much more difficult for COVID-19 patients with severe COVID-19 to get on their feet again.
The study was published by BMJ Open.
