Delirium in critically ill patients with COVID-19 pneumonia

The ICU delirium is a predictor of mortality, length of stay in hospital, time on ventilation, and long-term cognitive impairment. There is a well-established association between acute respiratory distress syndrome (ARDS) and ICU delirium. However, the profile and disease progression trajectory of COVID-19 patients with ICU delirium has not been studied. This case series reviews our institution’s experience in COVID-19 patients with ICU delirium. Of all four patients, two of them died in hospital, and the other two survived to the hospital discharge. The disease progressions were tracked, as well as the ICU delirium. Potential life-threatening complications and organ failure symptoms were also presented. To improve the patients’ overall health outcome, Haloperidol was prescribed with careful consideration.

Delirium; COVID-19; ICU

[1] Richman DD, Whitley RJ, Hayden FG. Clinical virology. 4th edn. Washington, DC: ASM Press. 2016.

[2] Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al. A novel coronavirus associated with severe acute respiratory syndrome. The New England Journal of Medicine. 2003; 348: 1953-1966.

[3] Kuiken T, Fouchier RA, Schutten M, Rimmelzwaan GF, van Amerongen G, van Riel D, et al. Newly discovered coronavirus as the primary cause of severe acute respiratory syndrome. The Lancet. 2003; 362: 263-270.

[4] Drosten C, Günther S, Preiser W, van der Werf S, Brodt HR, Becker S, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. The New England Journal of Medicine. 2003; 348: 1967-1976.

[5] de Groot RJ, Baker SC, Baric RS, Brown CS, Drosten C, Enjuanes L, et al. Middle East Respiratory Syndrome Coronavirus (MERS-CoV): announcement of the coronavirus study group. Journal of Virology. 2013; 87: 7790-7792.

[6] Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus ADME, Fouchier RAM. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. The New England Journal of Medicine. 2012; 367: 1814-1820.

[7] Wang W, Fasolino M, Cattau B, Goldman N, Kong W, Frederick MA, et al. Joint profiling of chromatin accessibility and CAR-T integration site analysis at population and single-cell levels. Proceedings of the National Academy of Sciences. 2020; 117: 5442-5452.

[8] Klankluang W, Pukrittayakamee P, Atsariyasing W, Siriussawakul A, Chanthong P, Tongsai S, et al. Validity and reliability of the Memorial Delirium Assessment Scale-Thai version (MDAS-T) for assessment of delirium in palliative care patients. The Oncologist. 2020; 25: e335-e340.

[9] Hosie A, Davidson PM, Agar M, Sanderson CR, Phillips J. Delirium prevalence, incidence, and implications for screening in specialist pal-liative care inpatient settings: a systematic review. Palliative Medicine. 2013; 27: 486-498.

[10] van Zyl LT, Seitz DP. Delirium concisely: condition is associated with increased morbidity, mortality, and length of hospitalization. Geriatrics. 2006; 61: 18-21.

[11] van den Boogaard M, Wassenaar A, van Haren FMP, Slooter AJC, Jorens PG, van der Jagt M, et al. Influence of sedation on delirium recognition in critically ill patients: a multinational cohort study. Australian Critical Care. 2020; 33: 420-425.

[12] Hsieh SJ, Soto GJ, Hope AA, Ponea A, Gong MN. The association between acute respiratory distress syndrome, delirium, and in-hospital mortality in intensive care unit patients. American Journal of Respiratory and Critical Care Medicine. 2015; 191: 71-78.

[13] Chen T, Chung Y, Chang H, Chen P, Wu C, Hsieh S, et al. Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: a bivariate meta-analysis. International Journal of Nursing Studies. 2021; 113: 103782.

[14] Zhao W, Hu Y, Chen H, Wang X, Wang L, Wang Y, et al. The effect and optimal dosage of dexmedetomidine plus sufentanil for postop-erative analgesia in elderly patients with postoperative delirium and early postoperative cognitive dysfunction: a single-center, prospective, randomized, double-blind, controlled trial. Frontiers in Neuroscience. 2020; 14: 549516.

[15] Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). Journal of the American Medical Association. 2001; 286: 2703-2710.

[16] Davis DHJ, Muniz Terrera G, Keage HAD, Stephan BCM, Fleming J, Ince PG, et al. Association of delirium with cognitive decline in late life: a neuropathologic study of 3 population-based cohort studies. JAMA Psychiatry. 2017; 74: 244-251.

[17] Girard TD, Exline MC, Carson SS, Hough CL, Rock P, Gong MN, et al. Haloperidol and ziprasidone for treatment of delirium in critical illness. The New England Journal of Medicine. 2018; 379: 2506-2516.

[18] Kotfis K, Williams Roberson S, Wilson JE, Dabrowski W, Pun BT, Ely EW. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Critical Care. 2020; 24: 176-184.