Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients
Abstract 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 t...
Main Authors: | , , , , , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-08-01
|
Series: | Critical Care |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s13054-020-03200-1 |
id |
doaj-c3b40ded9ce74b01a0041ff44ed7094e |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Julie Helms Stéphane Kremer Hamid Merdji Malika Schenck François Severac Raphaël Clere-Jehl Antoine Studer Mirjana Radosavljevic Christine Kummerlen Alexandra Monnier Clotilde Boulay Samira Fafi-Kremer Vincent Castelain Mickaël Ohana Mathieu Anheim Francis Schneider Ferhat Meziani |
spellingShingle |
Julie Helms Stéphane Kremer Hamid Merdji Malika Schenck François Severac Raphaël Clere-Jehl Antoine Studer Mirjana Radosavljevic Christine Kummerlen Alexandra Monnier Clotilde Boulay Samira Fafi-Kremer Vincent Castelain Mickaël Ohana Mathieu Anheim Francis Schneider Ferhat Meziani Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients Critical Care COVID-19 Delirium Encephalopathy ICU MRI |
author_facet |
Julie Helms Stéphane Kremer Hamid Merdji Malika Schenck François Severac Raphaël Clere-Jehl Antoine Studer Mirjana Radosavljevic Christine Kummerlen Alexandra Monnier Clotilde Boulay Samira Fafi-Kremer Vincent Castelain Mickaël Ohana Mathieu Anheim Francis Schneider Ferhat Meziani |
author_sort |
Julie Helms |
title |
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_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_sort |
delirium and encephalopathy in severe covid-19: a cohort analysis of icu patients |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2020-08-01 |
description |
Abstract 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. |
topic |
COVID-19 Delirium Encephalopathy ICU MRI |
url |
http://link.springer.com/article/10.1186/s13054-020-03200-1 |
work_keys_str_mv |
AT juliehelms deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT stephanekremer deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT hamidmerdji deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT malikaschenck deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT francoisseverac deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT raphaelclerejehl deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT antoinestuder deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT mirjanaradosavljevic deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT christinekummerlen deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT alexandramonnier deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT clotildeboulay deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT samirafafikremer deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT vincentcastelain deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT mickaelohana deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT mathieuanheim deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT francisschneider deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients AT ferhatmeziani deliriumandencephalopathyinseverecovid19acohortanalysisoficupatients |
_version_ |
1724706618307772416 |
spelling |
doaj-c3b40ded9ce74b01a0041ff44ed7094e2020-11-25T02:58:24ZengBMCCritical Care1364-85352020-08-0124111110.1186/s13054-020-03200-1Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patientsJulie Helms0Stéphane Kremer1Hamid Merdji2Malika Schenck3François Severac4Raphaël Clere-Jehl5Antoine Studer6Mirjana Radosavljevic7Christine Kummerlen8Alexandra Monnier9Clotilde Boulay10Samira Fafi-Kremer11Vincent Castelain12Mickaël Ohana13Mathieu Anheim14Francis Schneider15Ferhat Meziani16Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital CivilHôpitaux Universitaires de Strasbourg, Service d’imagerie 2, Hôpital de HautepierreHôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital CivilHôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, HautepierreHôpitaux Universitaires de Strasbourg, Groupe Méthodes en Recherche Clinique (GMRC), Hôpital CivilHôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital CivilHôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital CivilImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d’Immunologie et d’Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA)Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital CivilHôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital CivilService de Neurologie, Hôpitaux Universitaires de StrasbourgImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d’Immunologie et d’Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA)Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, HautepierreRadiology Department, Nouvel Hôpital Civil, Strasbourg University HospitalService de Neurologie, Hôpitaux Universitaires de StrasbourgHôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, HautepierreHôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital CivilAbstract 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.http://link.springer.com/article/10.1186/s13054-020-03200-1COVID-19DeliriumEncephalopathyICUMRI |