Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients

BACKGROUND: Neurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. We aimed at describing delirium and neurological symptoms of COVID-19 in ICU patients. METHODS: We conducted a bicentric cohort study in two French ICUs of Strasbourg University Hospital. All the 150...

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Autores principales: Helms, Julie, Kremer, Stéphane, Merdji, Hamid, Schenck, Malika, Severac, François, Clere-Jehl, Raphaël, Studer, Antoine, Radosavljevic, Mirjana, Kummerlen, Christine, Monnier, Alexandra, Boulay, Clotilde, Fafi-Kremer, Samira, Castelain, Vincent, Ohana, Mickaël, Anheim, Mathieu, Schneider, Francis, Meziani, Ferhat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414289/
https://www.ncbi.nlm.nih.gov/pubmed/32771053
http://dx.doi.org/10.1186/s13054-020-03200-1
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author Helms, Julie
Kremer, Stéphane
Merdji, Hamid
Schenck, Malika
Severac, François
Clere-Jehl, Raphaël
Studer, Antoine
Radosavljevic, Mirjana
Kummerlen, Christine
Monnier, Alexandra
Boulay, Clotilde
Fafi-Kremer, Samira
Castelain, Vincent
Ohana, Mickaël
Anheim, Mathieu
Schneider, Francis
Meziani, Ferhat
author_facet Helms, Julie
Kremer, Stéphane
Merdji, Hamid
Schenck, Malika
Severac, François
Clere-Jehl, Raphaël
Studer, Antoine
Radosavljevic, Mirjana
Kummerlen, Christine
Monnier, Alexandra
Boulay, Clotilde
Fafi-Kremer, Samira
Castelain, Vincent
Ohana, Mickaël
Anheim, Mathieu
Schneider, Francis
Meziani, Ferhat
author_sort Helms, Julie
collection PubMed
description BACKGROUND: Neurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. We aimed at describing delirium and neurological symptoms of COVID-19 in ICU patients. METHODS: We conducted a bicentric cohort study in two French ICUs of Strasbourg University Hospital. All the 150 patients referred for acute respiratory distress syndrome due to SARS-CoV-2 between March 3 and May 5, 2020, were included at their admission. Ten patients (6.7%) were excluded because they remained under neuromuscular blockers during their entire ICU stay. Neurological examination, including CAM-ICU, and cerebrospinal fluid analysis, electroencephalography, and magnetic resonance imaging (MRI) were performed in some of the patients with delirium and/or abnormal neurological examination. The primary endpoint was to describe the incidence of delirium and/or abnormal neurological examination. The secondary endpoints were to describe the characteristics of delirium, to compare the duration of invasive mechanical ventilation and ICU length of stay in patients with and without delirium and/or abnormal neurological symptoms. RESULTS: The 140 patients were aged in median of 62 [IQR 52; 70] years old, with a median SAPSII of 49 [IQR 37; 64] points. Neurological examination was normal in 22 patients (15.7%). One hundred eighteen patients (84.3%) developed a delirium with a combination of acute attention, awareness, and cognition disturbances. Eighty-eight patients (69.3%) presented an unexpected state of agitation despite high infusion rates of sedative treatments and neuroleptics, and 89 (63.6%) patients had corticospinal tract signs. Brain MRI performed in 28 patients demonstrated enhancement of subarachnoid spaces in 17/28 patients (60.7%), intraparenchymal, predominantly white matter abnormalities in 8 patients, and perfusion abnormalities in 17/26 patients (65.4%). The 42 electroencephalograms mostly revealed unspecific abnormalities or diffuse, especially bifrontal, slow activity. Cerebrospinal fluid examination revealed inflammatory disturbances in 18/28 patients, including oligoclonal bands with mirror pattern and elevated IL-6. The CSF RT-PCR SARS-CoV-2 was positive in one patient. The delirium/neurological symptoms in COVID-19 patients were responsible for longer mechanical ventilation compared to the patients without delirium/neurological symptoms. Delirium/neurological symptoms could be secondary to systemic inflammatory reaction to SARS-CoV-2. CONCLUSIONS AND RELEVANCE: Delirium/neurological symptoms in COVID-19 patients are a major issue in ICUs, especially in the context of insufficient human and material resources. TRIAL REGISTRATION: NA.
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spelling pubmed-74142892020-08-10 Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients Helms, Julie Kremer, Stéphane Merdji, Hamid Schenck, Malika Severac, François Clere-Jehl, Raphaël Studer, Antoine Radosavljevic, Mirjana Kummerlen, Christine Monnier, Alexandra Boulay, Clotilde Fafi-Kremer, Samira Castelain, Vincent Ohana, Mickaël Anheim, Mathieu Schneider, Francis Meziani, Ferhat Crit Care Research BACKGROUND: Neurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. We aimed at describing delirium and neurological symptoms of COVID-19 in ICU patients. METHODS: We conducted a bicentric cohort study in two French ICUs of Strasbourg University Hospital. All the 150 patients referred for acute respiratory distress syndrome due to SARS-CoV-2 between March 3 and May 5, 2020, were included at their admission. Ten patients (6.7%) were excluded because they remained under neuromuscular blockers during their entire ICU stay. Neurological examination, including CAM-ICU, and cerebrospinal fluid analysis, electroencephalography, and magnetic resonance imaging (MRI) were performed in some of the patients with delirium and/or abnormal neurological examination. The primary endpoint was to describe the incidence of delirium and/or abnormal neurological examination. The secondary endpoints were to describe the characteristics of delirium, to compare the duration of invasive mechanical ventilation and ICU length of stay in patients with and without delirium and/or abnormal neurological symptoms. RESULTS: The 140 patients were aged in median of 62 [IQR 52; 70] years old, with a median SAPSII of 49 [IQR 37; 64] points. Neurological examination was normal in 22 patients (15.7%). One hundred eighteen patients (84.3%) developed a delirium with a combination of acute attention, awareness, and cognition disturbances. Eighty-eight patients (69.3%) presented an unexpected state of agitation despite high infusion rates of sedative treatments and neuroleptics, and 89 (63.6%) patients had corticospinal tract signs. Brain MRI performed in 28 patients demonstrated enhancement of subarachnoid spaces in 17/28 patients (60.7%), intraparenchymal, predominantly white matter abnormalities in 8 patients, and perfusion abnormalities in 17/26 patients (65.4%). The 42 electroencephalograms mostly revealed unspecific abnormalities or diffuse, especially bifrontal, slow activity. Cerebrospinal fluid examination revealed inflammatory disturbances in 18/28 patients, including oligoclonal bands with mirror pattern and elevated IL-6. The CSF RT-PCR SARS-CoV-2 was positive in one patient. The delirium/neurological symptoms in COVID-19 patients were responsible for longer mechanical ventilation compared to the patients without delirium/neurological symptoms. Delirium/neurological symptoms could be secondary to systemic inflammatory reaction to SARS-CoV-2. CONCLUSIONS AND RELEVANCE: Delirium/neurological symptoms in COVID-19 patients are a major issue in ICUs, especially in the context of insufficient human and material resources. TRIAL REGISTRATION: NA. BioMed Central 2020-08-08 /pmc/articles/PMC7414289/ /pubmed/32771053 http://dx.doi.org/10.1186/s13054-020-03200-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Helms, Julie
Kremer, Stéphane
Merdji, Hamid
Schenck, Malika
Severac, François
Clere-Jehl, Raphaël
Studer, Antoine
Radosavljevic, Mirjana
Kummerlen, Christine
Monnier, Alexandra
Boulay, Clotilde
Fafi-Kremer, Samira
Castelain, Vincent
Ohana, Mickaël
Anheim, Mathieu
Schneider, Francis
Meziani, Ferhat
Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients
title Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients
title_full Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients
title_fullStr Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients
title_full_unstemmed Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients
title_short Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients
title_sort delirium and encephalopathy in severe covid-19: a cohort analysis of icu patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414289/
https://www.ncbi.nlm.nih.gov/pubmed/32771053
http://dx.doi.org/10.1186/s13054-020-03200-1
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