COVID-19 ICU patients at risk of acute brain dysfunction, says study
New Delhi: COVID-19 patients admitted to intensive care in the early months of the pandemic experienced a higher burden of delirium and coma than is typically found in those hospitalized with acute respiratory failure, according to the largest study of its kind to date.
The research, published in The Lancet Respiratory Medicine journal, tracked the incidence of delirium and coma in over 2,000 COVID-19 patients admitted before April 28, 2020, to 69 adult intensive care units across 14 countries.
According to the scientists, led by those at Vanderbilt University Medical Center in the US, the choice of sedative medications and curbs on family visitation played a role in increasing acute brain dysfunction for these patients.
They said ICU delirium is associated with higher medical costs and greater risk of death and long-term ICU-related dementia.
Nearly 82 percent of the patients in the study were comatose for a median of 10 days, and 55 percent were delirious for a median of three days.
The scientists noted that acute brain dysfunction lasted for an average of 12 days.
"This is double what is seen in non-COVID ICU patients," said study co-author Brenda Pun from VUMC.
The scientists believe COVID-19 could predispose patients to a higher burden of acute brain dysfunction.
However, they also noted that patient care factors, some of which are related to pressures posed on health care by the pandemic, also appear to have played a significant role.
With respect to COVID-19, the scientists believe there has been widespread abandonment of newer clinical protocols that are proven to help ward off the acute brain dysfunction that usually affects many critically ill patients.
"It is clear in our findings that many ICUs reverted to sedation practices that are not in line with best practice guidelines and we're left to speculate on the causes," Pun said.
"Early reports of COVID-19 suggested that the lung dysfunction seen required unique management techniques including deep sedation. In the process, key preventive measures against acute brain dysfunction went somewhat by the boards," she added.
Analyzing patient characteristics from electronic health records, and care practices, and findings from clinical assessments, the scientists found that about 90 percent of patients tracked in the study were invasively mechanical ventilated at some point during hospitalization, and 67 percent on the day of ICU admission.
Patients receiving benzodiazepine sedative infusions were at 59 percent higher risk of developing delirium, they added.
In comparison, the patients who received family visitation were at 30 percent lower risk of delirium, the study noted.
"There's no reason to think that, since the close of our study, the situation for these patients has changed," said study senior author, Pratik Pandharipande.
"These prolonged periods of acute brain dysfunction are largely avoidable. ICU teams need above all to return to lighter levels of sedation for these patients, frequent awakening and breathing trials, mobilization, and safe in-person or virtual visitation," Pandharipande added.
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Russian military hardware, spare parts for Indian military to be manufactured in India
New Delhi (PTI): Russia agreed to encourage joint manufacturing in India of military hardware and spare parts for maintenance of Russian-origin arms and defence equipment.
Ways to bolster overall bilateral defence cooperation figured prominently during summit talks between Prime Minister Narendra Modi and Russian President Vladimir Putin on Friday.
It has been a long-standing grievance of armed forces that the supply of critical spares and equipment from Russia takes a long time, affecting the maintenance of military systems procured from that country.
"Both sides agreed to encourage joint manufacturing in India of spare parts, components, aggregates and other products for maintenance of Russian origin arms and defence equipment under Make-in-India programme through transfer of technology," a joint statement said.
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It said both sides also agreed to set up joint ventures for meeting the needs of the Indian armed forces as well as subsequent export to mutually friendly third countries.
The joint statement said the India-Russia defence partnership is being reoriented to take up joint co-development and co-production of advanced defence technology and systems.
In their meeting on Thursday, Defence Minister Rajnath Singh and his Russian counterpart Andrey Belousov resolved to expand bilateral defence cooperation.
In the meeting, the Indian side showed keen interest in procurement of additional batches of S-400 missile systems from Moscow to bolster its combat prowess.
In October 2018, India signed a USD 5 billion deal with Russia to buy five units of the S-400 air defence missile systems, notwithstanding a warning by the US that going ahead with the contract may invite US sanctions under the provisions of Countering America's Adversaries Through Sanctions Act (CAATSA).
Three squadrons have already been delivered.
The S-400 systems played a crucial role during Operation Sindoor. India may also look at procuring the S-500 missile systems from Russia.
In the Modi-Putin talks, the two sides also agreed to continue jointly developing systems of bilateral trade settlements through the use of national currencies.
Additionally, the two sides agreed to continue their consultations on enabling the interoperability of the national payment systems, financial messaging systems, as well as central bank digital currency platforms.
Modi and Putin appreciated the ongoing intensification of the joint work on a free trade agreement on goods between India and the Eurasian Economic Union, covering sectors of mutual interest, the joint statement said.
They also directed both sides to intensify efforts in negotiations on a mutually beneficial agreement on the promotion and protection of investment, it said.
India and Russia also welcomed steps to ensure long-term supply of fertilisers to India and discussed the potential establishment of joint ventures in this area.
