It typically occurs in patients who have been sedated and put on a ventilator.

By Leah Groth
May 05, 2020
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For most people—about 80%, according to the World Health Organization—COVID-19 won't result in serious illness. But that still means 1 in 5 people who contract the infection will end up with a more severe form of the disease, and will need hospitalization. In the most severe cases—typically in those with underlying conditions like high blood pressure, heart and lung problems, or diabetes—COVID-19 patients may be admitted to a hospital's intensive care unit (ICU), where they can benefit from respiratory support through a ventilator.

According to multiple studies, the majority of patients admitted to the ICU and require ventilation do not survive. Data from the Intensive Care National Audit and Research Center in London shows that, of outcome data available for 690 ICU patients, 346 (or 50.1%) patients died, while 344 (49.9%) were discharged alive. Similar findings were shown in an Italian study published in JAMA: Of 1,581 patients with available ICU disposition data at the end of the study, 920 patients were still in the ICU—but of the remaining 661 patients, 405 (61.3%) died while 256 (38.7%) were discharged.

Of course, being discharged from the ICU is the best-case scenario—but sometimes, even after coming off of respiratory support, hospitalized patients can experience another issue: ICU delirium.

"Delirium is a state of confusion that commonly occurs when patients are in the ICU," Lauren Ferrante, MD, a Yale Medicine pulmonologist and critical care doctor, explains to Health. “The patient may not be able to think clearly, may not understand what is happening around them, and may see or hear things that are not there.”

Delirium is actually one part of a condition more broadly known as post-intensive care syndrome, or PICS, which is a collection of issues that can arise in patients who've spent time in the ICU. According to the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, delirium is common among hospitalized patients and can affect 2 out of 3 patients in ICU settings—it affects 7 out of 10 patients while they are on a ventilator, or soon after being taken off of one. The CIBS says that the symptoms of delirium include:

  • Not being able to think clearly.
  • Having trouble paying attention.
  • Having a hard time understanding what's going on around them.
  • Seeing or hearing things that are not there—though they seem very real.

Being isolated in an ICU is, essentially, a perfect scenario in which to develop delirium. “For example, the ICU is a noisy place with bright light, which can disrupt a patient’s normal sleep/wake cycle and contribute to delirium,” Dr. Ferrante explains. “As much as possible, we recommend trying to preserve a patient’s sleep/wake cycle, minimize sedating medications, and frequently orient patients in the hospital so they don’t become confused.” Other risk factors for developing delirium, per the CIBS, include:

  • When the brain receives less oxygen or is unable to use it.
  • Certain medicines.
  • Severe infections, pain, or medical illnesses.
  • Alcohol, sedatives, or pain killers—or withdrawal from those substances.

COVID-19 adds another layer to ICU delirium, says Dr. Ferrante. Novel coronavirus patients aren’t able to have their loved ones surrounding them, which has a calming effect. “Families are not allowed to visit due to concerns about spreading infection, so families are not at the bedside to help orient the patient. Normally, we ask families to help us keep their loved one oriented to person, place, time, and situation,” says Dr. Ferrante.

There are, of course, other reasons why delirium can occur, even for those not in the ICU. “Older age increases the risk of delirium, so many older adults who are admitted to a regular hospital floor may still become delirious,” she explains. Hearing problems and vision problems also contribute to delirium. “If a patient normally wears glasses for vision problems, or uses a hearing aid for hearing problems, it’s important for the patient to use these sensory aids in the hospital to decrease the chance of developing delirium,” she adds.

Luckily, when delirium comes on quickly—in hours or days, as it can with COVID-19 ICU patients—it doesn’t last forever. According to CIBS, it usually clears up after a few days or even a week, but some patients can experience lasting issues, including cognitive impairment, post-traumatic stress disorder, or depression.

The CIBS says the best way to help care for a loved one with delirium is to provide a comforting, patient, and understanding presence. That means speaking calmly and using simple words or phrases; talking about family and friends frequently; and decorating the room with reminders of home.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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