1. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study
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Ana Vallejo de la Cueva, Pablo T. Aznar, Laura González Cubillo, Chiara Robba, Oriol Plans Galván, Nerea Aretxabala Cortajarena, Robert C. Hyzy, Imen Ben Saida, Jorge Rubio, María José Sánchez Carretero, Katie M. Vance, Blanca Furquet, Irene Patricia Barón Barrera, Sarah J. Peterson, Sara C. LaHue, Sergio Llorente Damas, Andrew R. Vogel, Nihal Patel, Alejandro Suarez-de-la-Rica, Cristina Álvarez, Ricard Molina Latorre, Günseli Orhun, Karen Shephard, Marta Martín Martínez, Paula Castello-Mora, Guillem Navarra-Ventura, Michelle Woodham, Carmen Andrea Sanchis-Veryser, Annachiara Marra, Kristine Nelson, Carolina Ferrer Gómez, Francisco Javier Morán Gallego, Muhammed Elhadi, Sarah Cohen, María Esther Rodriguez Delgado, Rafael Badenes, Isabel Reyes García, Christopher Berkey, Karla Núñez Vázquez, Beata-Gabriela K Simpson, Amaia Quintano Rodero, María Pilar Vicente-Fernández, María Luisa García Pérez, Vanja C. Douglas, María Elena Martínez Quintana, Silvia García de Castrillón i Ramal, Silvia Beretta, Mandeep Sing, Robert A Balk, Yolanda Poveda Hernández, Spencer Roberson, Martin Siegemund, Jordi Morillas Pérez, Rameela Raman, Giuseppe Servillo, João Manoel Silva, Brenda T. Pun, Aurélien Mazeraud, María Cruz Martín Delgado, Borja Hinojal Olmedillo, Gemma Gomà Fernández, Miguel Valente, Michael T. Kenes, Laura Galarza, Fabio Silvio Taccone, Wencong Chen, Rita Pereia, Álvaro Ortega Guerrero, Morgan H. Tandy, Alejandro Ruiz Perea, Stephanie Wilson-Linville, Meri Martin Cerezuela, Salvatore Lucio Cutuli, Carlos A. Calvo, María de las Nieves Noci Moreno, Ariadna Bellès, Elisa Govea Bogossian, Mario Dalorzo González, Eva Álvarez Torres, David Díaz Muñoz, Carla Margarida Teixeira, Emilio del Campo Molina, Sol Fernandez-Gonzalo, Christine Harb, Berta Monleón, Anna Teresa Mazzeo, Beatriz Del Moral Barbudo, Thomas Godet, Cristina Delgado Palacios, C. Adrian Austin, Hilde Wøien, Anselmo Caricato, Erik Roman-Pognuz, Bruno Gonçalves, Patricia Rodríguez Villamizar, Eloisa Sofia Tanzarella, Daniel A Godoy Torres, Robert E. Hosse, Lisa Smit, María Rosa Sanchis-Martin, Cristina Murcia Gubianas, Emily Sanders, Karen Herrera-Davis, Sara Torrico Sánchez, Isabel Peña Luna, David A Bennett, Irene Torres, Diana Gil-Castillejos, Laura Labrador Romero, Felipe González-Seguel, Carlos Muñoz De Cabo, Ellis Morgan, Itziar Insausti, Mónica García Simón, Patricia Piñeiro Otero, Genís Carrasco Gómez, M. Montero, Jose García Cantos, Ignacio Garutti, César Rodriguez Nuñez, Fernando Higuero, Sameep Sehgal, Catherine M. Kuza, Yago García Blanco-Traba, Juan Romeu Prieto, Ainhoa Serrano, Elena Abril Palomares, Perihan Ergin Özcan, Mathieu van der Jagt, Elena Gallego Curto, Berta Gallego Rodríguez, Rosalía Navarro Casado, Aaron Lerner, Myrto Tzimou, Sheila Moya Gutiérrez, Beatriz García Góngora, Eleonora Stival, Xavier Andorrà Sunyer, Susana Gallardo Sánchez, Anna Baró Serra, Filadelfo Bustos Molina, Rafael Zaragoza, Verónica Rojas, Paolo Pelosi, Aris Pérez Lucendo, Stéphane Legriel, Eduardo Tobar, Laura Lizama, Viviane Hidalgo-Calibin, Chiara Maria Concetta Massaro, Nekane Romero, Pablo García Domelo, Isabel Jesus Pereira, Kelly Drumright, Frank Rasulo, Mattia Marchesi, Jacques Creteur, Estefanía Carvajal Revuelta, Timothy D. Girard, Pablo Carreño-Montenegro, Ana Montero Feijoo, Ignacio Baeza Gómez, Alba Gonzalo Millán, Esteban Morcillo, Alice Santos, Pilar Leal Sanz, Dulce Morales, Gabriel Heras La Calle, Hollis R. O’Neal, Antonio Ramírez-Palma, Inés Pérez Francisco, Alberto Noto, Matilde González Serrano, Paola Valls, María Jesús Mármol Cubillo, Emilio Maseda, Anna Estermann, Andrés Pujol, E. Wesley Ely, Alexis Ferré, Lucia Chowdhury, Guillaume Lacave, Cristina Granja, Isabel de la Calle Gil, Onur M Orun, Mohamed Boussarsar, David Pestaña Lagunas, Denise Battaglini, Nathan E. Brummel, Rosa María Pérez Manrique, Núria Zellweger, Jaume Puig, Kiran Devulapally, Milagros Calizaya Vargas, Jesús Caballero, Theresa Olasveengen, Cristina Fuster, Aarti Sarwal, Pratik P. Pandharipande, Gabriele Pintaudi, Paula Ramirez, Blanca Fernández Tomás, Maria Claudia Giménez Santamarina, Francisco Luis Pérez Caballero, Enver Rodriguez-Martinez, David Martínez-Gascueña, Irene Paredes Borrachero, Ugo Fraisse, Paloma LaTorre Andreu, Ignacio Catalán-Monzón, Elena Gonzalez, Figen Esen, Lorenzo Peluso, Intensive Care, Pun, B. T., Badenes, R., Heras La Calle, G., Orun, O. M., Chen, W., Raman, R., Simpson, B. -G. K., Wilson-Linville, S., Hinojal Olmedillo, B., Vallejo de la Cueva, A., van der Jagt, M., Navarro Casado, R., Leal Sanz, P., Orhun, G., Ferrer Gomez, C., Nunez Vazquez, K., Pineiro Otero, P., Taccone, F. S., Gallego Curto, E., Caricato, A., Woien, H., Lacave, G., O'Neal, H. R., Peterson, S. J., Brummel, N. E., Girard, T. D., Ely, E. W., Pandharipande, P. P., Creteur, J., Bogossian, E. G., Peluso, L., Gonzalez-Seguel, F., Hidalgo-Cabalin, V., Carreno-Montenegro, P., Rojas, V., Tobar, E., Ramirez-Palma, A., Herrera-Davis, K., Ferre, A., Legriel, S., Godet, T., Fraisse, U., Goncalves, B., Mazeraud, A., Tzimou, M., Rasulo, F., Beretta, S., Marchesi, M., Robba, C., Battaglini, D., Pelosi, P., Mazzeo, A. T., Noto, A., Servillo, G., Marra, A., Cutuli, S. L., Pintaudi, G., Stival, E., Tanzarella, E. S., Roman-Pognuz, E., Concetta Massaro, C. M., Elhadi, M., Smit, L., Olasveengen, T., Pereira, I. J., Teixeira, C. M., Santos, A., Valente, M., Granja, C., Pereia, R., Silva, J., Furquet, B., Garcia Simon, M., Godoy Torres, D. A., Monleon, B., Morcillo, E., Romero, N., Serrano, A., Torrico Sanchez, S., Perez Caballero, F. L., Pena Luna, I., Baeza Gomez, I., Calizaya Vargas, M., Morillas Perez, J., Carrasco Gomez, G., Molina Latorre, R., Moya Gutierrez, S., Baron Barrera, I. P., Delgado Palacios, C., Garcia Gongora, B., Labrador Romero, L., Galarza, L., Catalan-Monzon, I., Rodriguez-Martinez, E., Murcia Gubianas, C., Belles, A., Rodriguez Delgado, M. E., Caballero, J., Morales, D., Pujol, A., Rubio, J., Alvarez Torres, E., Carvajal Revuelta, E., de la Calle Gil, I., Fernandez Tomas, B., Gallego Rodriguez, B., Gonzalez Serrano, M., LaTorre Andreu, P., Perez Lucendo, A., Abril Palomares, E., Gonzalez Gonzalez, E., Martin Delgado, M. C., Munoz De Cabo, C., Aznar, P. T., Calvo, C. A., Garutti, I., Higuero, F., Martinez-Gascuena, D., Maseda, E., Insausti, I., Montero Feijoo, A., Suarez-de-la-Rica, A., Del Moral Barbudo, B., Garcia Blanco-Traba, Y., Gimenez Santamarina, M. C., Gonzalo Millan, A., Llorente Damas, S., Pestana Lagunas, D., Reyes Garcia, I., Ruiz Perea, A., Ortega Guerrero, A., Marmol Cubillo, M. J., Diaz Munoz, D., Garcia de Castrillon i Ramal, S., Andorra Sunyer, X., Noci Moreno, M. D. L. N., Perez Manrique, R. M., del Campo Molina, E., Martinez Quintana, M. E., Fernandez-Gonzalo, S., Goma Fernandez, G., Navarra-Ventura, G., Baro Serra, A., Fuster, C., Plans Galvan, O., Gil-Castillejos, D., Dalorzo Gonzalez, M., Moran Gallego, F. J., Paredes Borrachero, I., Rodriguez Villamizar, P., Romeu Prieto, J., Sanchez Carretero, M. J., Gallardo Sanchez, S., Bustos Molina, F., Garcia Perez, M. L., Castello-Mora, P., Puig, J., Sanchis-Martin, M. R., Sanchis-Veryser, C. A., Vicente-Fernandez, M. P., Zaragoza, R., Lizama, L., Torres, I., Alvarez, C., Ramirez, P., Martin Cerezuela, M., Montero, M. J., Garcia Cantos, J., Valls, P., Aretxabala Cortajarena, N., Garcia Domelo, P., Gonzalez Cubillo, L., Martin Martinez, M., Perez Francisco, I., Poveda Hernandez, Y., Quintano Rodero, A., Rodriguez Nunez, C., Siegemund, M., Estermann, A., Zellweger, N., Ben Saida, I., Boussarsar, M., Esen, F., Ergin Ozcan, P., Berkey, C., Harb, C., Tandy, M. H., Morgan, E., Shephard, K., Hyzy, R. C., Kenes, M., Nelson, K., Hosse, R. E., Vance, K. M., Austin, C. A., Lerner, A., Sanders, E., Balk, R. A., Bennett, D. A., Vogel, A. R., Chowdhury, L., Devulapally, K., Woodham, M., Cohen, S., Patel, N., Kuza, C. M., Sing, M., Roberson, S., Drumright, K., Sehgal, S., Lahue, S. C., Douglas, V. C., and Sarwal, A.
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,covid-19 ,delirium ,Outcomes ,Lower risk ,Critical Ilness ,Task-Force ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Intensive-Care-Unit ,Intensive care ,Settore MED/41 - ANESTESIOLOGIA ,medicine ,Survivors ,030212 general & internal medicine ,Simplified Acute Physiology Score ,Mechaniically Ventilated Patients ,Epitiomology ,Mechanical ventilation ,Coma ,Intensive-Care-Unit, Mechaniically Ventilated Patients, Clinical practice Guidelines, Critical Ilness, Task-Force, Sedation, ICU, Survivors, Outcomes, Epitiomology ,business.industry ,covid ,Retrospective cohort study ,Articles ,Clinical practice Guidelines ,covid, delirium ,030228 respiratory system ,Sedation ,ICU ,Emergency medicine ,Delirium ,medicine.symptom ,business ,Cohort study - Abstract
Background: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. Methods: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged ≥18 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Findings: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40·0 (30·0 to 53·0). 1397 (66·9%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87·5%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64·0%) of 2088 patients were given benzodiazepines for a median of 7·0 days (4·0 to 12·0) and 1481 (70·9%) were given propofol for a median of 7·0 days (4·0 to 11·0). Median Richmond Agitation–Sedation Scale score while on invasive mechanical ventilation was –4 (–5 to –3). 1704 (81·6%) of 2088 patients were comatose for a median of 10·0 days (6·0 to 15·0) and 1147 (54·9%) were delirious for a median of 3·0 days (2·0 to 6·0). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p≤0·04), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p
- Published
- 2021