Covid-19 likely to increase incidence of hospital delirium

GlobalData Healthcare 26 May 2020 (Last Updated May 26th, 2020 16:29)
Covid-19 likely to increase incidence of hospital delirium

As the Covid-19 pandemic continues to spread, there will be more patients who have severe Covid-19 and require longer intensive care unit (ICU) stays and ventilation. An estimated 70%-80% of these ventilated patients will experience ICU delirium, which causes patients to enter a confused state. This can lead to long-term cognitive impairments and memory deficits. Pharmacological treatments for ICU delirium may see an increase in administration as a result of the Covid-19 pandemic.

About 5% of Covid-19 patients need ICU hospitalisation. Patients who are ventilated spend a longer time in the ICU, remaining ventilated for up to two weeks. This puts these patients at an increased risk of developing post-intensive care syndromes, which cause physical, cognitive, and mental health problems even after leaving the ICU. ICU delirium is one of these issues and can cause patients to have even longer hospital stays and lower six-month survival. These cognitive impairments can persist for months to years after being discharged from the hospital.

ICU delirium is exacerbated by several aspects during a stay at the hospital. Covid-19 patients are isolated, resulting in less social and physical interaction. The virus may infiltrate and damage the brain or cause inflammation, limiting blood flow to the brain. In addition, ventilated patients are often sedated to suppress coughing or to help patients tolerate a breathing tube; however, these drugs can increase the risk of delirium, especially benzodiazepines, which could be more commonly used if other sedatives become in short supply.

Several treatments are used to reduce ICU delirium. There are non-pharmacological treatments such as music therapy, reduction in noise to prevent sleep deprivation, and mobilisation of patients. Pharmacological treatments include the reduction of sedatives and analgesics, and the administration of antipsychotics, atypical antipsychotics, cholinesterase inhibitors, and Alpha-2 agonists. The HELP programme has also created a Covid-19 delirium prevention toolkit, which offers caregivers some proven effective solutions for reducing delirium.

One of the most frequently used antipsychotic drugs used to treat ICU delirium patients is haloperidol, which has shown efficacy in reducing mortality, preventing delirium, and improving high-risk patient outcomes. Other second-generation atypical antipsychotics include risperidone, a pyridopyrimidines derivative that acts as psychotropic agent and is also used as a treatment for schizophrenia.

GlobalData had previously forecast the 2020 global delirium drug treatment market to be $335m. This estimate was based on past years’ annual statements and sourced broker reports prior to the Covid-19 pandemic; with the increased incidence of Covid-19 ICU admissions and resulting delirium rates, this estimate will increase.