A majority of severe COVID-19 patients hospitalized at Michigan Medicine early in the pandemic experienced delirium, according to a recent study published in BMJ Open.
Researchers analyzed data from 148 COVID-19 patients hospitalized at an Ann Arbor-based Michigan Medicine intensive care unit between March 1 and May 31, 2020.
Seven study findings:
1. Overall, 73 percent (108) of patients had delirium, a mental state marked by intense confusion and emotional disruption.
2. The median duration of delirium was 10 days.
3. Patients with delirium tended to be sicker, with more comorbidities such as hypertension and diabetes, and appeared to have more severe COVID-19 as well, said study author Phillip Vlisides, MD, anesthesiologist specialist and professor at Michigan Medicine.
4. COVID-19 itself can lead to reduced oxygen to the brain as well as the development of blood clots and stroke, resulting in cognitive impairment.
5. Inflammatory markers were greatly increased in COVID-19 patients with delirium. Inflammation of the brain can result in confusion and agitation.
6. Providers and care teams were often unable to perform standard delirium reduction techniques, such as exercises designed to get a patient moving or allowing visitors to orient patients while in the hospital. "Whatever creative ways we can implement delirium prevention protocols is likely to be very helpful," Dr. Vlisides said. "That includes consistent communication with family members, bringing in pictures and objects from home, and video visits if family cannot safely visit."
7. Almost a third of patients didn't have delirium marked as resolved in their chart upon discharge, and 40 percent of these patients required skilled nursing care. For some, symptoms of delirium lasted months after leaving the hospital.
Previous studies, also from early in the pandemic, have linked delirium to COVID-19 infection.