Vikram Dhawan, MD,
Memorial Sloan Kettering Cancer Center
New York
Disclosure information not submitted.
Louis Voigt, MD
Associate Attending. Department of Anesthesiology & Critical Care Medicine
Memorial Sloan Kettering Cancer Center, United States
Disclosure information not submitted.
Yesne Alici, MD
Associate Attending. Department of Psychiatry
Memorial Sloan Kettering Cancer Center, United States
Disclosure information not submitted.
Mehak Sharma, MD
Assistant Attending. Department of Psychiatry
Memorial Sloan Kettering Cancer Center, United States
Disclosure information not submitted.
Sanjay Chawla, BS, MD, FCCM
Associate Attending
Memorial Sloan Kettering - Anesthesia & CCM, United States
Disclosure information not submitted.
Christian Bjerre Real, MD, , MMCI
Memorial Sloan Kettering Cancer Center
New York, NY
Disclosure information not submitted.
Title: Adding Confusion to Chaos: Delirium in Critically Ill Cancer Patients with COVID
Introduction: COVID continues to be a devastating pandemic with little known of its neuropsychiatric complications. Delirium is the most common cognitive syndrome encountered among hospitalized cancer patients with incidence ranging from 25-40% and rates up to 85% in terminally ill. We evaluated the incidence and outcomes of delirium in critically ill COVID patients at our cancer center. To our knowledge this is the first study to evaluate delirium in critically ill cancer patients with COVID.
Methods: This was a retrospective single center observational study evaluating delirium in all critically ill cancer patients with COVID from 3/1/20-7/10/20. We excluded those admitted < 72 hours and those without cancer. Confusion Assessment Method-Intensive Care Unit (CAM-ICU) was performed at least twice daily and patients screened positive for delirium if CAM-ICU was positive at least once daily. Categorical variables were described using count and percent and compared using Fisher’s exact test. Continuous variables were described using median and interquartile range (IQR) and compared using Wilcoxon rank sum test.
Results: A total of 86 patients were evaluated. Of those, 57 (66.3%) were found to be positive for delirium. Patients with delirium were significantly older with median age of 67.4 years (61.5-71.5) compared to patients who did not have delirium (p < 0.002). There was no difference in other demographics, chronic medical conditions, neuropsychiatric history, cancer type or cancer directed therapy. Delirium patients were more likely to receive antipsychotics (84.2%), opioids (98.3%), benzodiazepines (96.5%) and paralytics (80.7%) and for longer duration. Delirium patients were more likely to be intubated (84.2%), undergo tracheostomy (33.3%) and receive Remdesivir (26.3%). There was no difference in application of proning between groups. ICU and hospital lengths of stay were significantly longer in delirium positive patients (p < 0.001), but there was no difference in hospital mortality (p < 0.363).
Conclusion: The incidence of delirium in this series of critically ill cancer patients with COVID was higher than reported in similar studies. Contrary to other studies we did not observe higher mortality in delirium patients. Other comorbidities were not a factor in the development of delirium in our population.