Kelley Chilson, PsyD
Fellow Clinical Psychology
Geisinger
Danville, Pennsylvania, United States
Disclosure information not submitted.
Erin Hall, PsyD
Clinical Health Psychologist
Geisinger Medical Center
Danville, Pennsylvania
Disclosure information not submitted.
Karen Korzick, MD, MA,FCCM
Program Director CCM Fellowship
Geisinger Medical Center Danville
Danville, Pennsylvania, United States
Disclosure information not submitted.
Title: Impact of Covid-19 on Medical ICU Delirium Rates and Severity
Introduction:
The impact of COVID-19 on ICU delirium rates is largely unknown. Our ICU Dashboard tracks ICU delirium rates using the CAM-ICU tool results. We noticed several differences in MICU delirium rates for the months of November to January 2019-2020 compared to the same months of 2020-2021 when our MICU was fully occupied by Covid-19 positive acute hypoxemic respiratory failure patients.
Methods:
To compare the rates of delirium in November, December, and January 2019 to the same 3 months in 2020-2021, we utilized ICU Dashboard filters specific to our campus that included ICU level of admission and the Medical ICU location.
Results:
The rate of delirium in MICU admissions was increased (November 35% vs 52%, December 42% vs 59%, and January 39% vs 69%). The number of ICU days patients experienced delirium also increased (November 27% vs 32%, December 35% vs 36%, and January 28% vs 43%.) Finally, the number of patients with severe delirium, defined as patients with CAM-ICU positive days > 5, also increased in two of the three months (November 13 vs 18, December 19 vs 19, and January 10 vs 24).
Conclusion:
We believe this descriptive data suggests that COVID-19 is associated with both an increased risk and severity of ICU delirium compared to a general MICU patient population without a COVID-19 diagnosis. It is well established that ICU patients are at high risk to develop delirium, even more so in those who require mechanical ventilation. It is likely that known risk factors for ICU delirium are magnified in patients with COVID-19, including greater illness severity, prolonged illness course and time on mechanical ventilation, heavy sedation use, prolonged immobilization, and isolation from staff and family members due to visitation restrictions. Factors unique to COVID-19 also increase the risk for delirium. These include the systemic inflammatory response linked to COVID-19, the occurrence of thrombotic events and microvascular insults, and multi-organ failure. Obtaining a better understanding of the relationship between COVID-19 and delirium is not only important for reducing mortality rates, but also to shed light on the importance of identifying targets to reduce delirium in this population. This in turn will also help to understand issues related to post-intensive care syndrome (PICS) and long-COVID.