Covid-19 ICU patients may experience higher burden of delirium, coma: Study

A study has found that Covid-19 patients admitted to intensive care during the early months of the outbreak faced a higher burden of delirium and coma than those who were hospitalised due to acute respiratory failure.

The study, published in The Lancet Respiratory Medicine journal, monitored the incidents of delirium and coma in over 2,000 Covid-19 patients. They were admitted before April 28, 2020, to 69 adult intensive care units across 14 countries.

The study noted that the choice of sedative medications and curbs on family visitations contributed to increasing acute brain dysfunction for these patients.

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The researchers stated that ICU delirium is associated with higher medical costs and a greater risk of death and long-term ICU-related dementia.

Furthermore, nearly 82 per cent of the patients in the study were comatose for a median of 10 days, and 55 per cent were delirious for a median of three days. The scientists noted that acute brain dysfunction lasted for an average of 12 days.

“This is double what is seen in non-Covid-19 ICU patients,” said study co-author Brenda Pun from VUMC.

“It is clear in our findings that many ICUs reverted to sedation practices that are not in line with best practice guidelines and we’re left to speculate on the causes,” Pun said.

“Early reports of Covid-19 suggested that the lung dysfunction seen required unique management techniques, including deep sedation. In the process, key preventive measures against acute brain dysfunction went somewhat by the boards,” she added.

The findings from clinical assessments suggested that about 90 per cent of patients were invasively mechanically ventilated at some point during hospitalisation, 67 per cent on the day of ICU admission.

They added that patients receiving benzodiazepine sedative infusions were at 59 per cent at higher risk of developing delirium.

In comparison, the patients who received family visitation were at 30 per cent lower risk of delirium, the study noted.

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“There’s no reason to think that, since the close of our study, the situation for these patients has changed,” said study senior author, Pratik Pandharipande.

“These prolonged periods of acute brain dysfunction are largely avoidable. ICU teams need above all to return to lighter levels of sedation for these patients, frequent awakening and breathing trials, mobilisation, and safe in-person or virtual visitations,” Pandharipande added.