Skip to main content
Top
Published in: Intensive Care Medicine 10/2021

01-10-2021 | SARS-CoV-2 | COVID-19 in Intensive Care

Delirium in COVID-19: can we make the unknowns knowns?

Authors: M. Elizabeth Wilcox, Manu Shankar-Hari, Daniel F. McAuley

Published in: Intensive Care Medicine | Issue 10/2021

Login to get access

Excerpt

Delirium is an important public health problem. It is independently associated with worse clinical outcomes, including persistent cognitive impairment, increased mortality, and greater risk of institutionalization [1]. The prevalence of delirium is high in the intensive care unit (ICU), occurring in up to 70% of the sickest patients requiring mechanical ventilation [1]. Early studies in hospitalized patients with coronavirus disease 2019 (COVID-19) report delirium rates of 20–30%, which increase to 60–70% in severe illness [1]. An international multicenter cohort study that included 69 adult ICUs across 14 countries of 2088 COVID-19 patients reported that over a 21-day period, delirium had a prevalence of 55% and lasted a median of 3 days (IQR, 2–6 days) [2], which is more common and prolonged than that in non-COVID cohorts. …
Literature
2.
go back to reference Pun BT, Badenes R, la HerasCalle G, Orun OM, Chen W, Raman R, Simpson BK, Wilson-Linville S, HinojalOlmedillo B, de la VallejoCueva A, van der Jagt M, Navarro Casado R, Leal Sanz P, Orhun G, Ferrer Gomez C, Nunez Vazquez K, Pineiro Otero P, Taccone FS, GallegoCurto E, Caricato A, Woien H, Lacave G, Neal HR, Peterson SJ, Brummel NE, Girard TD, Ely EW, Pandharipande PP, Group C-ICIS (2021) Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Med 9(3):239–250CrossRef Pun BT, Badenes R, la HerasCalle G, Orun OM, Chen W, Raman R, Simpson BK, Wilson-Linville S, HinojalOlmedillo B, de la VallejoCueva A, van der Jagt M, Navarro Casado R, Leal Sanz P, Orhun G, Ferrer Gomez C, Nunez Vazquez K, Pineiro Otero P, Taccone FS, GallegoCurto E, Caricato A, Woien H, Lacave G, Neal HR, Peterson SJ, Brummel NE, Girard TD, Ely EW, Pandharipande PP, Group C-ICIS (2021) Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Med 9(3):239–250CrossRef
4.
go back to reference Meinhardt J, Radke J, Dittmayer C, Franz J, Thomas C, Mothes R, Laue M, Schneider J, Brunink S, Greuel S, Lehmann M, Hassan O, Aschman T, Schumann E, Chua RL, Conrad C, Eils R, Stenzel W, Windgassen M, Rosler L, Goebel HH, Gelderblom HR, Martin H, Nitsche A, Schulz-Schaeffer WJ, Hakroush S, Winkler MS, Tampe B, Scheibe F, Kortvelyessy P, Reinhold D, Siegmund B, Kuhl AA, Elezkurtaj S, Horst D, Oesterhelweg L, Tsokos M, Ingold-Heppner B, Stadelmann C, Drosten C, Corman VM, Radbruch H, Heppner FL (2021) Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci 24:168–175CrossRef Meinhardt J, Radke J, Dittmayer C, Franz J, Thomas C, Mothes R, Laue M, Schneider J, Brunink S, Greuel S, Lehmann M, Hassan O, Aschman T, Schumann E, Chua RL, Conrad C, Eils R, Stenzel W, Windgassen M, Rosler L, Goebel HH, Gelderblom HR, Martin H, Nitsche A, Schulz-Schaeffer WJ, Hakroush S, Winkler MS, Tampe B, Scheibe F, Kortvelyessy P, Reinhold D, Siegmund B, Kuhl AA, Elezkurtaj S, Horst D, Oesterhelweg L, Tsokos M, Ingold-Heppner B, Stadelmann C, Drosten C, Corman VM, Radbruch H, Heppner FL (2021) Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci 24:168–175CrossRef
5.
go back to reference Brann DH, Tsukahara T, Weinreb C, Lipovsek M, Van den Berge K, Gong B, Chance R, Macaulay IC, Chou HJ, Fletcher RB, Das D, Street K, de Bezieux HR, Choi YG, Risso D, Dudoit S, Purdom E, Mill J, Hachem RA, Matsunami H, Logan DW, Goldstein BJ, Grubb MS, Ngai J, Datta SR (2020) Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia. Sci Adv 6:31CrossRef Brann DH, Tsukahara T, Weinreb C, Lipovsek M, Van den Berge K, Gong B, Chance R, Macaulay IC, Chou HJ, Fletcher RB, Das D, Street K, de Bezieux HR, Choi YG, Risso D, Dudoit S, Purdom E, Mill J, Hachem RA, Matsunami H, Logan DW, Goldstein BJ, Grubb MS, Ngai J, Datta SR (2020) Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia. Sci Adv 6:31CrossRef
6.
go back to reference Helms J, Kremer S, Merdji H, Schenck M, Severac F, Clere-Jehl R, Studer A, Radosavljevic M, Kummerlen C, Monnier A, Boulay C, Fafi-Kremer S, Castelain V, Ohana M, Anheim M, Schneider F, Meziani F (2020) Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients. Crit Care 24:491CrossRef Helms J, Kremer S, Merdji H, Schenck M, Severac F, Clere-Jehl R, Studer A, Radosavljevic M, Kummerlen C, Monnier A, Boulay C, Fafi-Kremer S, Castelain V, Ohana M, Anheim M, Schneider F, Meziani F (2020) Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients. Crit Care 24:491CrossRef
7.
go back to reference Song E, Zhang C, Israelow B, Lu-Culligan A, Prado AV, Skriabine S, Lu P, Weizman OE, Liu F, Dai Y, Szigeti-Buck K, Yasumoto Y, Wang G, Castaldi C, Heltke J, Ng E, Wheeler J, Alfajaro MM, Levavasseur E, Fontes B, Ravindra NG, van Dijk D, Mane S, Gunel M, Ring A, JaffarKazmi SA, Zhang K, Wilen CB, Horvath TL, Plu I, Haik S, Thomas JL, Louvi A, Farhadian SF, Huttner A, Seilhean D, Renier N, Bilguvar K, Iwasaki A (2021) Neuroinvasion of SARS-CoV-2 in human and mouse brain. J Exp Med. https://doi.org/10.1084/jem.20202135CrossRefPubMedPubMedCentral Song E, Zhang C, Israelow B, Lu-Culligan A, Prado AV, Skriabine S, Lu P, Weizman OE, Liu F, Dai Y, Szigeti-Buck K, Yasumoto Y, Wang G, Castaldi C, Heltke J, Ng E, Wheeler J, Alfajaro MM, Levavasseur E, Fontes B, Ravindra NG, van Dijk D, Mane S, Gunel M, Ring A, JaffarKazmi SA, Zhang K, Wilen CB, Horvath TL, Plu I, Haik S, Thomas JL, Louvi A, Farhadian SF, Huttner A, Seilhean D, Renier N, Bilguvar K, Iwasaki A (2021) Neuroinvasion of SARS-CoV-2 in human and mouse brain. J Exp Med. https://​doi.​org/​10.​1084/​jem.​20202135CrossRefPubMedPubMedCentral
8.
go back to reference Matschke J, Lutgehetmann M, Hagel C, Sperhake JP, Schroder AS, Edler C, Mushumba H, Fitzek A, Allweiss L, Dandri M, Dottermusch M, Heinemann A, Pfefferle S, Schwabenland M, Magruder DS, Bonn S, Prinz M, Gerloff C, Puschel K, Krasemann S, Aepfelbacher M, Glatzel M (2020) Neuropathology of patients with in Germany: a post-mortem case series. Lancet Neurol 19(11):919–929CrossRef Matschke J, Lutgehetmann M, Hagel C, Sperhake JP, Schroder AS, Edler C, Mushumba H, Fitzek A, Allweiss L, Dandri M, Dottermusch M, Heinemann A, Pfefferle S, Schwabenland M, Magruder DS, Bonn S, Prinz M, Gerloff C, Puschel K, Krasemann S, Aepfelbacher M, Glatzel M (2020) Neuropathology of patients with in Germany: a post-mortem case series. Lancet Neurol 19(11):919–929CrossRef
9.
go back to reference Fanou EM, Coutinho JM, Shannon P, Kiehl TR, Levi MM, Wilcox ME, Aviv RI, Mandell DM (2017) Critical illness-associated cerebral microbleeds. Stroke 48:1085–1087CrossRef Fanou EM, Coutinho JM, Shannon P, Kiehl TR, Levi MM, Wilcox ME, Aviv RI, Mandell DM (2017) Critical illness-associated cerebral microbleeds. Stroke 48:1085–1087CrossRef
10.
go back to reference Goldberg TE, Chen C, Wang Y, Jung E, Swanson A, Ing C, Garcia PS, Whittington RA, Moitra V (2020) Association of delirium with long-term cognitive decline: a meta-analysis1. JAMA Neurol 77(11):1373–1381CrossRef Goldberg TE, Chen C, Wang Y, Jung E, Swanson A, Ing C, Garcia PS, Whittington RA, Moitra V (2020) Association of delirium with long-term cognitive decline: a meta-analysis1. JAMA Neurol 77(11):1373–1381CrossRef
11.
go back to reference Girard TD, Thompson JL, Pandharipande PP, Brummel NE, Jackson JC, Patel MB, Hughes CG, Chandrasekhar R, Pun BT, Boehm LM, Elstad MR, Goodman RB, Bernard GR, Dittus RS, Ely EW (2018) Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study. Lancet Respir Med 6:213–222CrossRef Girard TD, Thompson JL, Pandharipande PP, Brummel NE, Jackson JC, Patel MB, Hughes CG, Chandrasekhar R, Pun BT, Boehm LM, Elstad MR, Goodman RB, Bernard GR, Dittus RS, Ely EW (2018) Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study. Lancet Respir Med 6:213–222CrossRef
12.
go back to reference van Gool WA, van de Beek D, Eikelenboom P (2010) Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 375:773–775CrossRef van Gool WA, van de Beek D, Eikelenboom P (2010) Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 375:773–775CrossRef
13.
go back to reference Philippens IHCHM, Böszörményi KP, Wubben JA, Fagrouch ZC, van Driel N, Mayenburg AQ, Lozovagia D, Roos E, Schurink B, Bugiani M, Bontrop RE, Middeldorp J, Bogers WM, de Geus-Oei L-F, Langermans JAM, Stammes MA, Verstrepen BE, Verschoor EJ (2021) SARSCoV2 causes brain inflammation and induces Lewy body formation in macaques. bioRxiv. https://doi.org/10.1101/2021.02.23.432474CrossRef Philippens IHCHM, Böszörményi KP, Wubben JA, Fagrouch ZC, van Driel N, Mayenburg AQ, Lozovagia D, Roos E, Schurink B, Bugiani M, Bontrop RE, Middeldorp J, Bogers WM, de Geus-Oei L-F, Langermans JAM, Stammes MA, Verstrepen BE, Verschoor EJ (2021) SARSCoV2 causes brain inflammation and induces Lewy body formation in macaques. bioRxiv. https://​doi.​org/​10.​1101/​2021.​02.​23.​432474CrossRef
14.
go back to reference Balas MC, Pun BT, Pasero C, Engel HJ, Perme C, Esbrook CL, Kelly T, Hargett KD, Posa PJ, Barr J, Devlin JW, Morse A, Barnes-Daly MA, Puntillo KA, Aldrich JM, Schweickert WD, Harmon L, Byrum DG, Carson SS, Ely EW, Stollings JL (2019) Common challenges to effective ABCDEF bundle implementation: the ICU liberation campaign experience. Crit Care Nurse 39:46–60CrossRef Balas MC, Pun BT, Pasero C, Engel HJ, Perme C, Esbrook CL, Kelly T, Hargett KD, Posa PJ, Barr J, Devlin JW, Morse A, Barnes-Daly MA, Puntillo KA, Aldrich JM, Schweickert WD, Harmon L, Byrum DG, Carson SS, Ely EW, Stollings JL (2019) Common challenges to effective ABCDEF bundle implementation: the ICU liberation campaign experience. Crit Care Nurse 39:46–60CrossRef
15.
go back to reference Morandi A, Piva S, Ely EW, Myatra SN, Salluh JIF, Amare D, Azoulay E, Bellelli G, Csomos A, Fan E, Fagoni N, Girard TD, Heras La Calle G, Inoue S, Lim CM, Kaps R, Kotfis K, Koh Y, Misango D, Pandharipande PP, Permpikul C, Cheng Tan C, Wang DX, Sharshar T, Shehabi Y, Skrobik Y, Singh JM, Slooter A, Smith M, Tsuruta R, Latronico N (2017) Worldwide survey of the “Assessing pain, both spontaneous awakening and breathing trials, choice of drugs, delirium monitoring/management, early exercise/mobility, and family empowerment” (ABCDEF) bundle. Crit Care Med 45:e1111–e1122CrossRef Morandi A, Piva S, Ely EW, Myatra SN, Salluh JIF, Amare D, Azoulay E, Bellelli G, Csomos A, Fan E, Fagoni N, Girard TD, Heras La Calle G, Inoue S, Lim CM, Kaps R, Kotfis K, Koh Y, Misango D, Pandharipande PP, Permpikul C, Cheng Tan C, Wang DX, Sharshar T, Shehabi Y, Skrobik Y, Singh JM, Slooter A, Smith M, Tsuruta R, Latronico N (2017) Worldwide survey of the “Assessing pain, both spontaneous awakening and breathing trials, choice of drugs, delirium monitoring/management, early exercise/mobility, and family empowerment” (ABCDEF) bundle. Crit Care Med 45:e1111–e1122CrossRef
Metadata
Title
Delirium in COVID-19: can we make the unknowns knowns?
Authors
M. Elizabeth Wilcox
Manu Shankar-Hari
Daniel F. McAuley
Publication date
01-10-2021
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 10/2021
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-021-06467-2

Other articles of this Issue 10/2021

Intensive Care Medicine 10/2021 Go to the issue

Imaging in Intensive Care Medicine

Idiopathic paroxysmal atrioventricular block