Delirium in critically ill COVID-19 patients: contributing factors and the association with health-related quality of life

Abstract

SARS-CoV-2 infection has been associated with delirium, an acute brain dysfunction very common in critical care. Critically ill COVID-19 patients have a high risk of delirium. In this context, this study aims to identify the occurrence of delirium in these patients, its contributing factors, and the association with health-related quality of life (HRQoL) post-discharge. This cross-sectional data is part of MAPA longitudinal project, with adult patients admitted with COVID-19 in Intensive Care Medicine Department (ICMD) of a University Hospital from October 2020 to August 2021. Exclusion criteria were: ICMD length of stay ≤24h, terminal illness, major auditory loss, or inability to communicate at follow-up. Patients' data were collected by clinical interview and chart review. HRQoL was evaluated using the 5-Level EQ-5D questionnaire at telephone follow-up appointment 1-2 months post-discharge. We included 131 patients (median age=62 years; 66% male; 21% had delirium in ICMD). Patients with delirium had a higher SAPS-II score, underwent more deep sedation, benzodiazepines perfusion, neuromuscular blockers (NMBA) and invasive mechanical ventilation (IMV) than patients without delirium. Patients with delirium did less high flow oxygen therapy, had more nosocomial infections, more difficulty weaning from MV and more tracheostomies. These patients also reported more pain/discomfort and anxiety/depression. Delirium is common in critically ill COVID-19 patients, particularly in those with higher SAPS-II score, deep sedation, benzodiazepines perfusion, NMBA, IMV, tracheostomies, and major ICU complications. Delirium was also associated with pain/discomfort and anxiety/depression post-discharge. In this way, preventive strategies and early screening of delirium are needed, to minimize its long-term consequences.