Delirium Incidence, Duration, and Severity in Critically Ill Patients With Coronavirus Disease 2019


Objectives: To determine delirium occurrence rate, duration, and severity in patients admitted to the ICU with coronavirus disease 2019.

Design: Retrospective data extraction study from March 1, 2020, to June 7, 2020. Delirium outcomes were assessed for up to the first 14 days in ICU.

Setting: Two large, academic centers serving the state of Indiana.

Patients: Consecutive patients admitted to the ICU with positive severe acute respiratory syndrome coronavirus 2 nasopharyngeal swab polymerase chain reaction test from March 1, 2020, to June 7, 2020, were included. Individuals younger than 18 years of age, without any delirium assessments, or without discharge disposition were excluded.

Measurements and main results: Primary outcomes were delirium rates and duration, and the secondary outcome was delirium severity. Two-hundred sixty-eight consecutive patients were included in the analysis with a mean age of 58.4 years (sd, 15.6 yr), 40.3% were female, 44.4% African American, 20.7% Hispanic, and a median Acute Physiology and Chronic Health Evaluation II score of 18 (interquartile range, 13-25). Delirium without coma occurred in 29.1% of patients, delirium prior to coma in 27.9%, and delirium after coma in 23.1%. The first Confusion Assessment Method for the ICU assessment was positive for delirium in 61.9%. Hypoactive delirium was the most common subtype (87.4%). By day 14, the median number of delirium/coma-free were 5 days (interquartile range, 4-11 d), and median Confusion Assessment Method for the ICU-7 score was 6.5 (interquartile range, 5-7) indicating severe delirium. Benzodiazepines were ordered for 78.4% of patients in the cohort. Mechanical ventilation was associated with greater odds of developing delirium (odds ratio, 5.0; 95% CI, 1.1-22.2; p = 0.033) even after adjusting for sedative medications. There were no between-group differences in mortality.

Conclusions: Delirium without coma occurred in 29.1% of patients admitted to the ICU. Delirium persisted for a median of 5 days and was severe. Mechanical ventilation was significantly associated with odds of delirium even after adjustment for sedatives. Clinical attention to manage delirium duration and severity, and deeper understanding of the virus' neurologic effects is needed for patients with coronavirus disease 2019.

Cite As
Khan, S. H., Lindroth, H., Perkins, A. J., Jamil, Y., Wang, S., Roberts, S., Farber, M., Rahman, O., Gao, S., Marcantonio, E. R., Boustani, M., Machado, R., & Khan, B. A. (2020). Delirium Incidence, Duration, and Severity in Critically Ill Patients With Coronavirus Disease 2019. Critical Care Explorations, 2(12).
Dr. Lindroth is supported by National Heart, Lung, Blood Institute (NHLBI) T32 5T32HL091816-07. Drs. Perkins, Gao, and B.A. Khan are supported through National Institute on Aging (NIA) R01 AG 055391, R01 AG 052493, and NHLBI R01 HL131730. Dr. Perkins is also supported by NIA grants 1K23AG062555-01 and R01AG056325. Dr. Machado is supported by 1R01HL111656, 1R01HL127342, and 1R01HL133951. Dr. Wang is supported by K23AG062555-01. Dr. Marcantonio is supported by grants R01AG044518 and K24AG035075 from the NIA. Dr. Boustani received funding from NIA R01AG034205 and disclosed that he has ownership equity in two for profit companies, Preferred Population Health Management and RestUp. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Critical Care Explorations
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