In this article the authors hypothesized that the rate of neurological complications would be higher in COVID-19 associated acute respiratory distress syndrome (ARDS) than those who develop ARDS from a different cause. They conducted a retrospective cohort study in the adult intensive care unit (ICU) of their hospital, including all consecutive patients fulfilling Berlin criteria for ARDS hospitalized between December 2017 and June 2021, stratifying exposure between COVID-19 or not. The primary outcome was delirium onset during ICU stay, defined by the confusion assessment method (CAM-ICU). Exploratory outcomes included development of neurological complications of the central (stroke, hemmorhage, vasculitis) or critical illness weakness, and 30 and 180 days all-cause mortality.
311 patients were included in the study (253 with COVID-19 and 58 with other causes); CAM-ICU was assessed in 231 (74.3% in COVID-19 vs. 74,1% in non-COVID-19). The proportion of patients developing delirium was similar in patients with COVID-19 and controls in univariate comparison (69.1% vs 60.5%, P=0.246). Yet, COVID-19 patients had higher body mass index, lower ICU severity, longer mechanical ventilation, and higher sedation doses (propofol, dexmedetomidine). After adjusting for these factors in COVID-19 patients in a multivariable analysis, the risk of delirium remained comparable across groups (adjusted odds ratio (OR) (95% CI): 0.86 (0.35-2.1)). Similarly, COVID-19 related ARDS had no impact on all-cause mortality at 30 days (adjusted OR: 0.87 (0.39-1.92)) and 180 days (adjusted OR: 0.67 (0.33-1.35)). Finally, neurological complications affecting the central nervous system (adjusted OR: 1.15 (0.25-5.29)) and critical illness weakness (adjusted OR: 2.99 (0.97-9.1)) were not higher in the COVID-19 group. The authors concluded that compared to other etiologies, patients with COVID-19 did not have higher incidence of delirium and other neurological complications, after accounting for underlying disease severity in ARDS patients. Management of COVID-19 associated ARDS needed longer invasive ventilation and higher sedation, which could explain higher rates of delirium in uncontrolled studies.
Bernard-Valnet R, Favre E, Bernini A, Oddo M, Chiche JD, Du Pasquier RA, Rossetti A; CORO-NEURO-ICU study group. Delirium in Adults With COVID-19-related ARDS: Comparison With Other Etiologies. Neurology. 2022 Aug 25:10.1212/WNL.0000000000201162.