Acute brain dysfunction in COVID-19 intensive care patients can be mitigated with care and contact

Written by: Blaine Caslin
Edited by: Esther Melamed

While the vaccine rollout is bringing a glimmer of hope for the pandemic, many people are still getting hospitalized for COVID-19 and needing to be treated in the intensive care unit (ICU). Doctors and scientists are continuing to develop new clinical guidelines and models of care to save the lives of COVID-19 patients and to reduce the prevalence of chronic health problems in survivors.

A recent study published in The Lancet Respiratory Medicine examined acute brain dysfunction in severely affected COVID-19 patients in the ICU in hopes of  identifying risk factors and optimizing medical  treatments. Acute brain dysfunction (ABD) describes delirium and/or coma observed in the  majority of ICU patients. ABD significantly lengthens the duration of patient stays in the ICU, reduces survival rates, and even increases the risk of lasting cognitive impairment or dementia post discharge. The latest updates to ICU protocols emphasize the need for regular cognitive assessments and use of milder sedatives in order to mitigate the risk of ABD¹.

Pun & Badenes et al.² examined the ABD rates in 2,088 COVID-19 patients during the 21 days following their admission to the ICU along with performing regression analyses of demographics, behaviors, and treatments as potential risk factors. The authors found that 82% of COVID subjects experienced coma and 55% experienced delirium during this period, with symptoms lasting twice as long as what is typically seen in non-COVID respiratory ICU patients. Factors such as male sex, history of alcohol or tobacco use, and older age were all associated with increased risk for ABD, which is consistent with other studies on COVID-19 prognosis and mortality. However, while a patient’s demographics and past history cannot be altered, some modifiable risk factors were also identified. Benzodiazepine administration was found to increase the number of days spent with ABD, while interaction with visitors was strongly protective. Indeed, in the limited number of facilities which allowed some form of visitor access to the ICU, contact with family or friends was found to reduce next-day ABD risk by 27% regardless of whether it was conducted virtually or in-person.

Sadly, the pandemic’s effects on society may have exacerbated ABD in these patients as much as the pathology of the virus itself. These data were collected in May of 2020, a period in which many of the participating hospitals were experiencing overcrowded ICUs and medical supply shortages. Staff were stretched thin at these facilities, with 84% reporting that they were forced to add beds to their ICUs and 42% describing their available resources as inadequate. In many cases, the decision to use benzodiazepines as sedatives instead of milder, safer alternatives was determined by material scarcity rather than ignorance of best practices. And of course, social interaction with severely ill COVID-19 patients is particularly difficult in a time when even healthy people must remain isolated from one another. The authors advise that modern standards for reducing ABD in ICU patients be maintained and that family contact be encouraged, even virtually, in order to mitigate long-lasting harm during what we all hope to be the last stages of the pandemic.