Researchers are exposing the numerous catastrophic repercussions that patients might suffer both during and after hospitalization more than a year into the COVID-19 epidemic.
A new research revealed that 73 percent of COVID patients hospitalized at the start of the pandemic had delirium, a severe mental disorder in which a patient is confused, agitated, and unable to think properly.
According to research author Phillip Vlisides, M.D., of the Department of Anesthesiology at Michigan Medicine, patients with delirium were sicker, had more comorbidities including hypertension and diabetes, and looked to have more severe COVID-related disease.
He went on to say, “COVID is also linked to a variety of other negative outcomes that tend to extend hospitalization and make recovery harder.”
The study team tried to uncover common threads among patients who experienced delirium by using patient medical data and telephone questionnaires after hospital discharge for a sample of patients admitted to the critical care unit between March and May 2020. According to Vlisides, several variables are at work.
The condition can cause a lack of oxygen in the brain, as well as the formation of blood clots and strokes, all of which can contribute to cognitive impairment. Furthermore, in individuals with delirium, inflammatory markers were significantly elevated. Inflammation of the brain can cause confusion and agitation.
To make matters worse, care providers were frequently unable to use typical delirium reduction strategies like exercises to keep patients moving or allowing visits or things from home to orient patients while in the hospital.
“We weren’t doing normal delirium prevention practices like we generally do early on in the pandemic,” Vlisides explained. We had little personal protective equipment and were attempting to reduce COVID exposure and disease transmission early in the pandemic, in the pre-vaccine era.”
Furthermore, there was a link between sedative usage and delirium, with patients with delirium being sedated more frequently and at greater dosages. “IV sedatives are commonly used in the ICU, especially for patients on a ventilator. However, based on our discussions with nurses, we discovered that patients with severe COVID were intrinsically more delirious and agitated at the outset, perhaps leading to more sedative use.”
The study also discovered that cognitive impairment might continue long after a patient has been discharged. Almost a third of patients’ delirium was not noted as resolved in their charts when they were discharged, and 40% of these patients required professional nursing care. According to their caretaker’s evaluation, over a quarter of the patients tested positive for delirium. These symptoms lingered for months in some people. This can make the process of recovering after a hospital stay much more challenging.
“A confused family member has little ability to care for oneself and will require more caretaking help, which is a significant challenge.”
Vlisides admits that care teams are doing the best they can with the resources they have, especially as the number of COVID patients continues to rise.
He believes that “whatever inventive methods we can deploy delirium prevention procedures will likely be extremely helpful.” “This includes keeping in touch with family members, bringing in photos and artifacts from home, and video visits if family members are unable to visit safely.”
He also advises family members and other caregivers who are struggling to care for a loved one to get support from their primary care physician as soon as possible.
The take-home message is that cognitive impairment, including depression and delirium, is extremely likely in individuals hospitalized with severe COVID-19, he noted.
“Overall, this research demonstrates another another reason why being vaccinated and avoiding serious disease is critical. Long-term neurological problems can occur, which we may not discuss as much as we should.”