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Delirium added to list of complications in COVID-19 patients

HOUSTON – We know COVID-19 can affect smell and taste, which is an indication it can affect the nervous system. So, it comes as no surprise to ICU physicians that the virus can cause delirium. The big surprise is how it's affecting more of those patients and they're younger.

Delirium is a common complication for patients in the hospital. Actually, 40% of patients may experience this, according to Ahmed Salem, MD, with Baylor College of Medicine, it usually is that frequent because the patients tend to be older and already have dementia, stroke, Parkinson’s or other sensory illnesses.

Salem works with patients at the Micheal E. Debakey VA, Baylor St. Luke’s and Ben Taub hospitals and said coronavirus is causing delirium in 30, 40 and 50-year-olds.

“What has been surprising is seeing it on such a large scale and also affecting younger patients. Seeing delirium in an aging population in the ICU, it’s not something new but what we’re seeing with COVID-19 is a severe respiratory illness on a scale that we have not seen in this generation before, and so we’re seeing a lot of younger patients affected by delirium as well which is not something that we had seen commonly before,” Salem said.

He said COVID-19 makes for a perfect storm to cause delirium.

“Patients with decreased mobility, who are away from their family, with sensory impairment, unable to really have regular sleep/wake cycle and also they are on medication to remain comfortable on a ventilator, essentially these are all conditions or situations that can give rise to pretty profound delirium,” Salem said.

Salem added any fever or infection can also cause delirium, even for patients who are treated at home.

Here are the signs of delirium:

  • Patient unable to retain focus
  • Can’t recall events in chronological order
  • The patient may appear to be withdrawn, less responsive
  • Then there’s the hyperactive delirium: that’s where the patient is very agitated and may even be combative or have hallucinations

To prevent it in the hospital, Salem said, “We try to make sure that we mobilize them as much as possible, keep them awake during the day, allow them to get a good night’s sleep, those interventions, though simple, go along way in trying to mitigate delirium.”

So is delirium long term? Among coronavirus survivors, that’s not yet known.

However, with other illnesses, this is an indication that dementia or some other neurological complication can affect patients long term.