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ICU Delirium in the Era of the COVID-19 Pandemic

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Annual Update in Intensive Care and Emergency Medicine 2021

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

The coronavirus disease 19 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a public health threat worldwide since December 2019. Apart from respiratory system involvement and systemic critical illness it has become obvious that SARS-CoV-2 can cause acute brain dysfunction in the form of delirium. Data have shown that delirium occurs in 45–84% of COVID-19 patients, may be the first presenting symptom, and leads to a worse prognosis. Increased risk factors for delirium are associated with medical management (sedative strategies to aid mechanical ventilation in patients with acute respiratory distress syndrome [ARDS], prolonged mechanical ventilation, prone positioning, immobilization), neurotrophic potential of the virus (direct central nervous system invasion, induction of inflammatory response mediators, multiple organ and system failure) and organizational issues (isolation from relatives and friends). Despite a heavy workload and multiple clinical challenges, the standard of care for critically ill patients, including delirium screening, prevention and management, should remain at the highest possible level, with the guidance of the ABCDEF bundle. Thorough assessment to identify ICU delirium and appropriate clinical management is necessary to limit its duration and severity. In this chapter, we discuss the epidemiology and risk factors for delirium in intensive care unit (ICU) patients, as well as identifying the sources of ICU delirium amidst the COVID-19 pandemic to help healthcare professionals limit the burden. Issues related to the post-COVID syndrome and post-intensive care syndrome (PICS) are also highlighted. Future research should concentrate on the understanding of the pathobiology of the virus and its neurotrophic potential to develop protective strategies for this and future coronavirus pandemics.

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Acknowledgement

The authors would like to thank Ms. Marta Janowska at www.yanoskyy.pl for help with preparation of the Figures.

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Authors and Affiliations

  1. Department Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland

    K. Kotfis

  2. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA

    J. E. Wilson & E. W. Ely

  3. Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    J. E. Wilson

  4. Geriatric Research, Education and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN, USA

    J. E. Wilson & E. W. Ely

  5. Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    E. W. Ely

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  1. K. Kotfis
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  3. E. W. Ely
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Correspondence to K. Kotfis .

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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Kotfis, K., Wilson, J.E., Ely, E.W. (2021). ICU Delirium in the Era of the COVID-19 Pandemic. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2021. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-73231-8_23

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  • DOI: https://doi.org/10.1007/978-3-030-73231-8_23

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