A CASE REPORT OF COVID-19 ASSOCIATED HYPERACTIVE ICU DELIRIUM WITH PROPOSED PATHOPHYSIOLOGY AND TREATMENT

Abstract There have been increasing reports of neuropsychiatric presentations and symptoms of COVID-19, more commonly seen in severely ill patients. Delirium, which is highly prevalent in general intensive care unit (ICU) populations, is expected to be frequent and prominent in COVID-19 patients hospitalized with acute respiratory distress syndrome (ARDS) in ICU. In this case report with associated review, we present a case of a critically ill patient with COVID-19 managed in ICU for ARDS. Psychiatry was consulted for management of her hyperactive delirium, likely complicated by environmental factors inherent in management of COVID-19 patients as well as the use of multiple sedatives. Patient was successfully managed by psychiatry with a combination of high-dose melatonin, suvorexant, guanfacine, intravenous haloperidol, and intravenous valproic acid. In addition to case presentation, we discuss a proposed delirium pathophysiology in COVID-19 associated delirium and a systematized approach to evaluation and management of such patients.