RT Journal Article
T1 Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study.
A1 Pun, Brenda T
A1 Badenes, Rafael
A1 Heras La Calle, Gabriel
A1 Orun, Onur M
A1 Chen, Wencong
A1 Raman, Rameela
A1 Simpson, Beata-Gabriela K
A1 Wilson-Linville, Stephanie
A1 Hinojal Olmedillo, Borja
A1 Vallejo de la Cueva, Ana
A1 van der Jagt, Mathieu
A1 Navarro Casado, Rosalía
A1 Leal Sanz, Pilar
A1 Orhun, Günseli
A1 Ferrer Gómez, Carolina
A1 Núñez Vázquez, Karla
A1 Piñeiro Otero, Patricia
A1 Taccone, Fabio Silvio
A1 Gallego Curto, Elena
A1 Caricato, Anselmo
A1 Woien, Hilde
A1 Lacave, Guillaume
A1 O'Neal, Hollis R
A1 Peterson, Sarah J
A1 Brummel, Nathan E
A1 Girard, Timothy D
A1 Ely, E Wesley
A1 Pandharipande, Pratik P
A1 COVID-19 Intensive Care International Study Group, 
AB To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged ≥18 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40·0 (30·0 to 53·0). 1397 (66·9%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87·5%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64·0%) of 2088 patients were given benzodiazepines for a median of 7·0 days (4·0 to 12·0) and 1481 (70·9%) were given propofol for a median of 7·0 days (4·0 to 11·0). Median Richmond Agitation-Sedation Scale score while on invasive mechanical ventilation was -4 (-5 to -3). 1704 (81·6%) of 2088 patients were comatose for a median of 10·0 days (6·0 to 15·0) and 1147 (54·9%) were delirious for a median of 3·0 days (2·0 to 6·0). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p≤0·04), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium, and thus these data present an opportunity to reduce acute brain dysfunction in patients with COVID-19. None. For the French and Spanish translations of the abstract see Supplementary Materials section.
YR 2021
FD 2021-01-08
LK https://hdl.handle.net/10668/25962
UL https://hdl.handle.net/10668/25962
LA en
DS RISalud
RD Apr 12, 2025