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Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation
BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in patients with COVID-19 acute respiratory distress syndrome (ARDS). We aim to assess the characteristics of delirium and describe its association with sedation and in-hospital mortality. METHODS: We retrospectively...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248255/ https://www.ncbi.nlm.nih.gov/pubmed/37305142 http://dx.doi.org/10.3389/fmed.2023.1172063 |
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author | Sun, Philip Young-woo Fanning, Jonathon Peeler, Anna Shou, Benjamin Lindsley, John Caturegli, Giorgio Whitman, Glenn Cha, Stephanie Kim, Bo Soo Cho, Sung-Min |
author_facet | Sun, Philip Young-woo Fanning, Jonathon Peeler, Anna Shou, Benjamin Lindsley, John Caturegli, Giorgio Whitman, Glenn Cha, Stephanie Kim, Bo Soo Cho, Sung-Min |
author_sort | Sun, Philip Young-woo |
collection | PubMed |
description | BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in patients with COVID-19 acute respiratory distress syndrome (ARDS). We aim to assess the characteristics of delirium and describe its association with sedation and in-hospital mortality. METHODS: We retrospectively reviewed adult patients on VV-ECMO for severe COVID-19 ARDS in the Johns Hopkins Hospital ECMO registry in 2020–2021. Delirium was assessed by the Confusion Assessment Method for the ICU (CAM-ICU) when patients scored−3 or above on the Richmond Agitation-Sedation Scale (RASS). Primary outcomes were delirium prevalence and duration in the proportion of days on VV-ECMO. RESULTS: Of 47 patients (median age = 51), 6 were in a persistent coma and 40 of the remaining 41 patients (98%) had ICU delirium. Delirium in the survivors (n = 21) and non-survivors (n = 26) was first detected at a similar time point (VV-ECMO day 9.5(5,14) vs. 8.5(5,21), p = 0.56) with similar total delirium days on VV-ECMO (9.5[3.3, 16.8] vs. 9.0[4.3, 28.3] days, p = 0.43). Non-survivors had numerically lower RASS scores on VV-ECMO days (−3.72[−4.42, −2.96] vs. −3.10[−3.91, −2.21], p = 0.06) and significantly prolonged delirium-unassessable days on VV-ECMO with a RASS of −4/−5 (23.0[16.3, 38.3] vs. 17.0(6,23), p = 0.03), and total VV-ECMO days (44.5[20.5, 74.3] vs. 27.0[21, 38], p = 0.04). The proportion of delirium-present days correlated with RASS (r = 0.64, p < 0.001), the proportions of days on VV-ECMO with a neuromuscular blocker (r = −0.59, p = 0.001), and with delirium-unassessable exams (r = −0.69, p < 0.001) but not with overall ECMO duration (r = 0.01, p = 0.96). The average daily dosage of delirium-related medications on ECMO days did not differ significantly. On an exploratory multivariable logistic regression, the proportion of delirium days was not associated with mortality. CONCLUSION: Longer duration of delirium was associated with lighter sedation and shorter paralysis, but it did not discern in-hospital mortality. Future studies should evaluate analgosedation and paralytic strategies to optimize delirium, sedation level, and outcomes. |
format | Online Article Text |
id | pubmed-10248255 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-102482552023-06-09 Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation Sun, Philip Young-woo Fanning, Jonathon Peeler, Anna Shou, Benjamin Lindsley, John Caturegli, Giorgio Whitman, Glenn Cha, Stephanie Kim, Bo Soo Cho, Sung-Min Front Med (Lausanne) Medicine BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in patients with COVID-19 acute respiratory distress syndrome (ARDS). We aim to assess the characteristics of delirium and describe its association with sedation and in-hospital mortality. METHODS: We retrospectively reviewed adult patients on VV-ECMO for severe COVID-19 ARDS in the Johns Hopkins Hospital ECMO registry in 2020–2021. Delirium was assessed by the Confusion Assessment Method for the ICU (CAM-ICU) when patients scored−3 or above on the Richmond Agitation-Sedation Scale (RASS). Primary outcomes were delirium prevalence and duration in the proportion of days on VV-ECMO. RESULTS: Of 47 patients (median age = 51), 6 were in a persistent coma and 40 of the remaining 41 patients (98%) had ICU delirium. Delirium in the survivors (n = 21) and non-survivors (n = 26) was first detected at a similar time point (VV-ECMO day 9.5(5,14) vs. 8.5(5,21), p = 0.56) with similar total delirium days on VV-ECMO (9.5[3.3, 16.8] vs. 9.0[4.3, 28.3] days, p = 0.43). Non-survivors had numerically lower RASS scores on VV-ECMO days (−3.72[−4.42, −2.96] vs. −3.10[−3.91, −2.21], p = 0.06) and significantly prolonged delirium-unassessable days on VV-ECMO with a RASS of −4/−5 (23.0[16.3, 38.3] vs. 17.0(6,23), p = 0.03), and total VV-ECMO days (44.5[20.5, 74.3] vs. 27.0[21, 38], p = 0.04). The proportion of delirium-present days correlated with RASS (r = 0.64, p < 0.001), the proportions of days on VV-ECMO with a neuromuscular blocker (r = −0.59, p = 0.001), and with delirium-unassessable exams (r = −0.69, p < 0.001) but not with overall ECMO duration (r = 0.01, p = 0.96). The average daily dosage of delirium-related medications on ECMO days did not differ significantly. On an exploratory multivariable logistic regression, the proportion of delirium days was not associated with mortality. CONCLUSION: Longer duration of delirium was associated with lighter sedation and shorter paralysis, but it did not discern in-hospital mortality. Future studies should evaluate analgosedation and paralytic strategies to optimize delirium, sedation level, and outcomes. Frontiers Media S.A. 2023-05-25 /pmc/articles/PMC10248255/ /pubmed/37305142 http://dx.doi.org/10.3389/fmed.2023.1172063 Text en Copyright © 2023 Sun, Fanning, Peeler, Shou, Lindsley, Caturegli, Whitman, Cha, Kim, Cho and HERALD investigators. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Sun, Philip Young-woo Fanning, Jonathon Peeler, Anna Shou, Benjamin Lindsley, John Caturegli, Giorgio Whitman, Glenn Cha, Stephanie Kim, Bo Soo Cho, Sung-Min Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation |
title | Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation |
title_full | Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation |
title_fullStr | Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation |
title_full_unstemmed | Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation |
title_short | Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation |
title_sort | characteristics of delirium and its association with sedation and in-hospital mortality in patients with covid-19 on veno-venous extracorporeal membrane oxygenation |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248255/ https://www.ncbi.nlm.nih.gov/pubmed/37305142 http://dx.doi.org/10.3389/fmed.2023.1172063 |
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