Patients have terrifying delirium
Kim Victory was paralyzed on a bed and being burned alive.
Just in time, someone rescued her, but suddenly, she was turned into an ice sculpture on a fancy cruise ship buffet. Next, she was a subject of an experiment in a lab in Japan. Then she was being attacked by cats.
Nightmarish visions such as these plagued Victory during her hospitalization this spring for severe respiratory failure caused by the coronavirus. They made her so agitated that one night she pulled out her ventilator breathing tube; another time, she fell off a chair and landed on the floor of the intensive care unit.
“It was so real, and I was so scared,” said Victory, 31, now back home in Franklin, Tenn.
To a startling degree, many coronavirus patients are reporting similar experiences. Called hospital delirium, the phenomenon has previously been seen mostly in a subset of older patients, some of whom already had dementia, and in recent years, hospitals adopted measures to reduce it.
“All of that has been erased by COVID,” said Dr. E. Wesley Ely, a director of the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University and the Nashville Veteran’s Administration Hospital, whose team developed guidelines for hospitals to minimize delirium.
Now, the condition is bedeviling coronavirus patients of all ages with no previous cognitive impairment. Reports from hospitals and researchers suggest that about two-thirds to three-fourths of coronavirus patients in ICUs have experienced it in various ways. Some have “hyperactive delirium,” paranoid hallucinations and agitation; some have “hypoactive delirium,” internalized visions and confusion that cause patients to become withdrawn and incommunicative; and some have both.
The experiences are not just terrifying and disorienting. Delirium can have detrimental consequences long after it lifts, extending hospital stays, slowing recovery and increasing people’s risk of developing depression or post-traumatic stress disorder. Previously healthy older patients with delirium can develop dementia sooner than they otherwise would have and can die earlier, researchers have found.
“There’s increased risk for temporary or even permanent cognitive deficits,” said Dr. Lawrence Kaplan, director of consultation liaison psychiatry at the University of California, San Francisco Medical Center. “It is actually more devastating than people realize.”
The ingredients for delirium are pervasive during the pandemic. They include long stints on ventilators, heavy sedatives and poor sleep. Other factors: Patients are mostly immobile, occasionally restrained to keep them from accidentally disconnecting tubes, and receive minimal social interaction because families cannot visit and medical providers wear face-obscuring protective gear and spend limited time in patients’ rooms.
“It’s like the perfect storm to generate delirium; it really, really is,” said Dr. Sharon Inouye, a leading delirium expert who founded the Hospital Elder Life Program, guidelines that have helped to significantly decrease delirium among older patients.