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White L, Jackson T. Delirium and COVID-19: a narrative review of emerging evidence. Anaesthesia. 2022;77:49-58doi: 10.1111/anae.15627.
White, L., & Jackson, T. (2022). Delirium and COVID-19: a narrative review of emerging evidence. Anaesthesia, 7749-58. https://doi.org/10.1111/anae.15627
White, L, and Jackson, T. "Delirium and COVID-19: a narrative review of emerging evidence." Anaesthesia vol. 77 (2022): 49-58. doi: https://doi.org/10.1111/anae.15627
White L, Jackson T. Delirium and COVID-19: a narrative review of emerging evidence. Anaesthesia. 2022 Jan;77:49-58. doi: 10.1111/anae.15627. PMID: 35001383.
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Anaesthesia. 2022 Jan;77:49-58. doi: 10.1111/anae.15627.

Delirium and COVID-19: a narrative review of emerging evidence.

Anaesthesia

L White, T Jackson

Affiliations

  1. Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
  2. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

PMID: 35001383 DOI: 10.1111/anae.15627

Abstract

Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with COVID-19 in hospital settings, and the occurrence is higher than expected for similar infections. The short-term outcomes of those with COVID-19 delirium are similar to that of classical delirium and include increased length of stay and increased mortality. Management of delirium in COVID-19 in the context of a global pandemic is limited by the severity of the syndrome and compounded by the environmental constraints. Practical management includes effective screening, early identification and appropriate treatment aimed at minimising complications and timely escalation decisions. The pandemic has played out on the national stage and the effect of delirium on patients, relatives and healthcare workers remains unknown but evidence from the previous SARS outbreak suggests there may be long-lasting psychological damage.

© 2022 Association of Anaesthetists.

Keywords: COVID-19; acute encephalopathy; delirium; inflammation

References

  1. Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nature Reviews Disease Primers 2020; 6: 90. - PubMed
  2. Maclullich A, Anand A, Davis D, et al. New horizons in the pathogenesis, assessment and management of delirium. Age and Ageing 2013; 42: 667-74. - PubMed
  3. Slooter AJ, Otte WM, Devlin JW, et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten societies. Intensive Care Medicine 2020; 46: 1020-2. - PubMed
  4. Gunther M, Morandi A, Ely E. Pathophysiology of delirium in the intensive care unit. Critical Care Clinics 2008; 24: 45-65. - PubMed
  5. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. Journal of the American Medical Association 1996; 275: 852-7. - PubMed
  6. Magny E, Le Petitcorps H, Pociumban M, et al. Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: a prospective case series. PLoS One 2018; 13: e0193034. - PubMed
  7. World Health Organization. WHO Coronavirus (COVID-19) dashboard. 2021. https://covid19.who.int/ (accessed 17/10/2021). - PubMed
  8. Regional Geriatric Program of Toronto. COVID-19 in older adults. 2021. https://www.rgptoronto.ca/wp-content/uploads/2020/04/COVID-19-Presentations-in-Frail-Older-Adults-U-of-C-and-U-fo-T.pdf (accessed 17/10/2021). - PubMed
  9. Aviv-Reuven S, Rosenfeld A. Publication patterns’ changes due to the COVID-19 pandemic: a longitudinal and short-term scientometric analysis. Scientometrics 2021; 126: 6761-84. - PubMed
  10. Sanders BJ, Bakar M, Mehta S, et al. Hyperactive delirium requires more aggressive management in patients with COVID-19: temporarily rethinking “low and slow”. Journal of Pain and Symptom Management 2020; 60: e31-2. - PubMed
  11. Sarangi A, McMahon T, Gude J. Benzodiazepine misuse: an epidemic within a pandemic. Cureus 2021; 13: e15816. - PubMed
  12. Howard R, Burns A, Schneider L. Antipsychotic prescribing to people with dementia during COVID-19. Lancet Neurology 2020; 19: 892. - PubMed
  13. Maldonado JR. Delirium pathophysiology: an updated hypothesis of the etiology of acute brain failure. International Journal of Geriatric Psychiatry 2017; 33: 1428-57. - PubMed
  14. 4AT. Rapid clinical test for delirium. https://www.the4at.com (accessed 17/10/2021). - PubMed
  15. Scottish Intercollegiate Guidelines Network. Risk reduction and management of delirium. 2019. https://www.sign.ac.uk/sign-157-delirium (accessed 17/10/2021). - PubMed
  16. Lipowski ZJ. Transient cognitive disorders (delirium, acute confusional states) in the elderly. Psychosomatic Medicine and Liaison Psychiatry 1983; 140: 289-306. - PubMed
  17. Sepulveda E, Leonard M, Franco JG, et al. Subsyndromal delirium compared with delirium, dementia, and subjects without delirium or dementia in elderly general hospital admissions and nursing home residents. Alzheimers Dementia 2016; 7: 1-10. - PubMed
  18. Bowman EML, Cunningham EL, Page VJ, McAuley DF. Phenotypes and subphenotypes of delirium: a review of current categorisations and suggestions for progression. Critical Care 2021; 25: 34. - PubMed
  19. Rogers JP, Watson CJ, Badenoch J, et al. Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives. Journal of Neurology, Neurosurgery and Psychiatry 2021; 92: 932-41. - PubMed
  20. Ostuzzi G, Gastaldon C, Papola D, et al. Pharmacological treatment of hyperactive delirium in people with COVID-19: rethinking conventional approaches. Therapeutic Advances in Psychopharmacology 2020; 10: 204512532094270. - PubMed
  21. O'Hanlon S, Inouye SK. Delirium: a missing piece in the COVID-19 pandemic puzzle. Age and Ageing 2020; 49: 497-8. - PubMed
  22. Krewulak KD, Stelfox HT, Leigh JP, Ely EW, Fiest KM. Incidence and prevalence of delirium subtypes in an adult ICU: a systematic review and meta-analysis. Critical Care Medicine 2018; 46: 2029-35. - PubMed
  23. Semple D, Howlett MM, Strawbridge JD, Breatnach CV, Hayden JC. A systematic review and pooled prevalence of delirium in critically Ill children. Critical Care Medicine 2021. Epub 16 August. https://doi.org/10.1097/CCM.0000000000005260 - PubMed
  24. Collins N, Blanchard MR, Tookman A, Sampson EL. Detection of delirium in the acute hospital. Age and Ageing 2009; 39: 131-5. - PubMed
  25. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine 2018; 46: e825-73. - PubMed
  26. Geriatric Medicine Research Collaborative. Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day. BMC Medicine 2019; 17: 229. - PubMed
  27. López-López C, Robleda-Font G, Frade-Mera MJ, et al. Clinical practice guidelines of the American College of Critical Care Medicine for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients. Enfermería Intensiva (English ed) 2019; 30: 38-42. - PubMed
  28. Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in Critical Care. Critical Care Clinics 2017; 33: 225-43. - PubMed
  29. National Institute for Health and Care Excellence. Overview: Delirium: Prevention, diagnosis and management. [CG103] 2019. https://www.nice.org.uk/Guidance/CG103 (accessed 17/10/2021). - PubMed
  30. Pagali S, Fu S, Lindroth H, Sohn S, Burton MC, Lapid M. Delirium occurrence and association with outcomes in hospitalized COVID-19 patients. International Psychogeriatrics 2021; 33: 1105-9. - PubMed
  31. Garcez FB, Aliberti MJR, Poco PCE, et al. Delirium and adverse outcomes in hospitalized patients with COVID-19. Journal of the American Geriatrics Society 2020; 68: 2440-6. - PubMed
  32. Helms J, Kremer S, Merdji H, et al. Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients. Critical Care 2020; 24: 491. - PubMed
  33. Shao S-C, Lai C-C, Chen Y-H, Chen Y-C, Hung M-J, Liao S-C. Prevalence, incidence and mortality of delirium in patients with COVID-19: a systematic review and meta-analysis. Age and Ageing 2021; 50: 1445-53. - PubMed
  34. Pun BT, Badenes R, Heras La Calle G, et al. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respiratory Medicine 2021; 9: 239-50. - PubMed
  35. Ely EW. Delirium as a predictor of mortality in mechanically ventilated patients in the Intensive Care Unit. Journal of the American Medical Association 2004; 291: 1753. - PubMed
  36. Jackson JC, Gordon SM, Hart RP, Hopkins RO, Ely EW. The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychology Review 2004; 14: 87-98. - PubMed
  37. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. Journal of the American Geriatrics Society 2003; 51: 591-8. - PubMed
  38. Dani M, Owen LH, Jackson TA, Rockwood K, Sampson EL, Davis D. Delirium, frailty, and mortality: interactions in a prospective study of hospitalized older people. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2018; 73: 415-8. - PubMed
  39. Tian J, Chen X, Liu D. Prediction of length of hospital stay and mortality in patients with delirium: a prospective cohort analysis of 200 ICU patients. Journal of Biological Regulators and Homeostatic Agents 2018; 32: 681-5. - PubMed
  40. Klein Klouwenberg PM, Zaal IJ, Spitoni C, et al. The attributable mortality of delirium in critically ill patients: prospective cohort study. British Medical Journal 2014; 349: g6652. - PubMed
  41. Mcloughlin BC, Miles A, Webb TE, et al. Functional and cognitive outcomes after COVID-19 delirium. European Geriatric Medicine 2020; 11: 857-62. - PubMed
  42. Age and Ageing Geriatric Medicine Research Collaborative, Covid Collaborative, Welch C. Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age and Ageing 2021; 50: 617-30. - PubMed
  43. Goldberg TE, Chen C, Wang Y, et al. Association of delirium with long-term cognitive decline: a meta-analysis. Journal of the American Medical Association Neurology 2020; 77: 1373-81. - PubMed
  44. Davis DH, Muniz Terrera G, Keage H, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based Cohort Study. Brain 2012; 135: 2809-16. - PubMed
  45. Hampshire A, Trender W, Chamberlain SR, et al. Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine 2021; 39: 101044. - PubMed
  46. Frontera JA, Melmed K, Fang T, et al. Toxic metabolic encephalopathy in hospitalized patients with COVID-19. Neurocritical Care 2021; 16: 1-14. - PubMed
  47. Casey CP, Lindroth H, Mohanty R, et al. Postoperative delirium is associated with increased plasma neurofilament light. Brain 2019; 143: 47-54. - PubMed
  48. Prudencio M, Erben Y, Marquez CP, et al. Serum neurofilament light protein correlates with unfavorable clinical outcomes in hospitalized patients with COVID-19. Science Translational Medicine 2021; 13:eabi7643. - PubMed
  49. Kanberg N, Simrén J, Edén A, et al. Neurochemical signs of astrocytic and neuronal injury in acute COVID-19 normalizes during long-term follow-up. EBioMedicine 2021; 70: 103512. - PubMed
  50. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: Consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033-4. - PubMed
  51. Pranata R, Huang I, Lim MA, Yonas E, Vania R, Kuswardhani RA. Delirium and mortality in coronavirus disease 2019 (COVID-19) - a systematic review and meta-analysis. Archives of Gerontology and Geriatrics 2021; 95: 104388. - PubMed
  52. Hughes CG, Pandharipande PP, Thompson JL, et al. Endothelial activation and blood-brain barrier injury as risk factors for delirium in critically ill patients. Critical Care Medicine 2016; 44: e809-17. - PubMed
  53. Meinhardt J, Radke J, Dittmayer C, et al. Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nature Neuroscience 2021; 24: 168-75. - PubMed
  54. Khan M, Yoo S-J, Marnick Clijsters M, et al. Visualizing in deceased COVID-19 patients how SARS-CoV-2 attacks the respiratory and olfactory mucosae but spares the olfactory bulb. Cell 2021; 184: 5932-49. - PubMed
  55. Michael BD, Bricio-Moreno L, Sorensen EW, et al. Astrocyte- and neuron-derived CXCL1 drives neutrophil transmigration and blood-brain barrier permeability in viral encephalitis. Cell Reports 2020; 32: 108150. - PubMed
  56. Engel GL, Romano J. Delirium, a syndrome of cerebral insufficiency. Journal of Chronic Diseases 1959; 9: 260-77. - PubMed
  57. Hosp JA, Dressing A, Blazhenets G, et al. Cognitive impairment and altered cerebral glucose metabolism in the subacute stage of COVID-19. Brain 2021; 144: 1263-76. - PubMed
  58. Shaw RC, Walker G, Elliott E, Quinn TJ. Occurrence rate of delirium in acute stroke settings. Stroke 2019; 50: 3028-36. - PubMed
  59. Perry RJ, Smith CJ, Roffe C, et al. Characteristics and outcomes of COVID-19 associated stroke: a UK multicentre case-control study. Journal of Neurology, Neurosurgery and Psychiatry 2020; 92: 242-8. - PubMed
  60. Wenzel J, Lampe J, Müller-Fielitz H, et al. The SARS-CoV-2 main protease Mpro causes microvascular brain pathology by cleaving NEMO in brain endothelial cells. Nature Neuroscience 2021; 24: 1522-33. - PubMed
  61. Frontera JA, Valdes E, Huang J, et al. Prevalence and impact of hyponatremia in patients with coronavirus disease 2019 in New York City. Critical Care Medicine 2020; 48: e1211-7. - PubMed
  62. López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. The hallmarks of aging. Cell 2013; 153: 1194-217. - PubMed
  63. Camell CD, Yousefzadeh MJ, Zhu Y, et al. Senolytics reduce coronavirus-related mortality in old mice. Science 2021;373:eabe4832. - PubMed
  64. Swarbrick CJ, Partridge JSL. Evidence-based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia 2022; 77 (Suppl 1): 92-101. - PubMed
  65. National Institute for Health and Care Excellence. Epilepsies: diagnosis and management. [CG137]. 2021. https://www.nice.org.uk/guidance/cg137 (accessed 17/10/2021). - PubMed
  66. British National Formulary. Dexamethasone. 2021. https://bnf.nice.org.uk/drug/dexamethasone.html (accessed 17/10/2021). - PubMed
  67. Wu Z, Li H, Liao K, Wang Y. Association between dexamethasone and delirium in critically ill patients: a retrospective cohort study of a large clinical database. Journal of Surgical Research 2021; 263: 89-101. - PubMed
  68. Clemmesen CG, Lunn TH, Kristensen MT, Palm H, Foss NB. Effect of a single pre-operative 125 mg dose of methylprednisolone on postoperative delirium in hip fracture patients; a randomised, double-blind, placebo-controlled trial. Anaesthesia 2018; 73: 1353-60. - PubMed
  69. Kluger MT, Skarin M, Collier J, et al. Steroids to reduce the impact on delirium (STRIDE): a double-blind, randomised, placebo-controlled feasibility trial of pre-operative dexamethasone in people with hip fracture. Anaesthesia 2021; 76: 1031-41. - PubMed
  70. British Geriatrics Society. Coronavirus: managing delirium in confirmed and suspected cases. 2021. https://www.bgs.org.uk/resources/coronavirus-managing-delirium-in-confirmed-and-suspected-cases (accessed 17/10/2021). - PubMed
  71. Dawson C, Capewell R, Ellis S, et al. Dysphagia presentation and management following coronavirus disease 2019: an acute care tertiary centre experience. Journal of Laryngology and Otology 2020; 134: 981-6. - PubMed
  72. British Geriatrics Society. Increasing participation of older people in research. 2021. https://www.bgs.org.uk/resources/increasing-participation-of-older-people-in-research (accessed 17/10/2021). - PubMed
  73. Kuusisto-Gussmann E, Höckelmann C, von der Lühe V, Schmädig R, Baltes M, Stephan A. Patients’ experiences of delirium: a systematic review and meta-summary of qualitative research. Journal of Advanced Nursing 2021; 77: 3692-706. - PubMed
  74. Laitinen H. Patients' experience of confusion in the intensive care unit following cardiac surgery. Intensive and Critical Care Nursing 1996; 12: 79-83. - PubMed
  75. Instenes I, Gjengedal E, Eide LSP, et al. "eight days of nightmares … " - octogenarian patients' experiences of postoperative delirium after transcatheter or surgical aortic valve replacement. Heart, Lung and Circulation 2018; 27: 260-6. - PubMed
  76. Namba M, Morita T, Imura C, Kiyohara E, Ishikawa S, Hirai K. Terminal delirium: families' experience. Palliative Medicine 2007; 21: 587-94. - PubMed
  77. O'Malley G, Leonard M, Meagher D, O'Keeffe ST. The delirium experience: a review. Journal of Psychosomatic Research 2008; 65: 223-8. - PubMed
  78. Breitbart W, Gibson C, Tremblay A. The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics 2002; 43: 183-94. - PubMed
  79. Lou M-F, Dai Y-T. Nurses' experience of caring for delirious patients. Journal of Nursing Research 2002; 10: 279-90. - PubMed
  80. Lee AM, Wong JGWS, McAlonan GM, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Canadian Journal of Psychiatry 2007; 52: 233-40. - PubMed
  81. Devlin JW, Fong JJ, Fraser GL, Riker RR. Delirium assessment in the critically ill. Intensive Care Medicine 2007; 33: 929-40. - PubMed
  82. Butler M, Watson C, Rooney A, et al. The Neurology and Neuropsychiatry of COVID-19. 2021. https://blogs.bmj.com/jnnp/2020/05/01/the-neurology-and-neuropsychiatry-of-covid-19 (accessed 17/10/2021). - PubMed

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