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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US SC rejects 26/11 attack accused Tahawwur Rana’s plea seeking stay on his extradition to India
New York, Apr 7 (PTI): The US Supreme Court has rejected 26/11 Mumbai terror attack accused Tahawwur Rana's appeal seeking a stay on his extradition to India, moving him closer to being handed over to Indian authorities to face justice.
Rana, 64, a Canadian national of Pakistani origin, is currently lodged at a metropolitan detention centre in Los Angeles.
He is known to be associated with Pakistani-American terrorist David Coleman Headley, one of the main conspirators of the 26/11 attacks. Headley conducted a recce of Mumbai before the attacks by posing as an employee of Rana’s immigration consultancy.
Rana had submitted an ‘Emergency Application For Stay Pending Litigation of Petition For Writ of Habeas Corpus' on February 27, 2025, with Associate Justice of the Supreme Court of the United States and Circuit Justice for the Ninth Circuit Elena Kagan.
Kagan had denied the application earlier last month.
Rana had then renewed his ‘Emergency Application for Stay Pending Litigation of Petition for Writ of Habeas Corpus previously addressed to Justice Kagan’, and requested that the renewed application be directed to US Chief Justice John Roberts.
An order on the Supreme Court website noted that Rana's renewed application had been “distributed for Conference” on April 4 and the “application” has been “referred to the Court.”
A notice on the Supreme Court website Monday said that “Application denied by the Court.”
Rana was convicted in the US of one count of conspiracy to provide material support to the terrorist plot in Denmark and one count of providing material support to Pakistan-based terrorist organisation Lashker-e-Taiba which was responsible for the attacks in Mumbai.
New York-based Indian-American attorney Ravi Batra had told PTI that Rana had made his application to the Supreme Court to prevent extradition, which Justice Kagan denied on March 6. The application was then submitted before Roberts, “who has shared it with the Court to conference so as to harness the entire Court’s view.”
The Supreme Court justices are Associate Justice Clarence Thomas, Associate Justice Samuel A. Alito, Jr., Associate Justice Sonia Sotomayor, Associate Justice Elena Kagan, Associate Justice Neil M. Gorsuch, Associate Justice Brett M. Kavanaugh, Associate Justice Amy Coney Barrett, and Associate Justice Ketanji Brown Jackson.
In his emergency application, Rana had sought a stay of his extradition and surrender to India pending litigation (including exhaustion of all appeals) on the merits of his February 13.
In that petition, Rana argued that his extradition to India violates US law and the UN Convention Against Torture "because there are substantial grounds for believing that, if extradited to India, the petitioner will be in danger of being subjected to torture."
"The likelihood of torture in this case is even higher though as petitioner faces acute risk as a Muslim of Pakistani origin charged in the Mumbai attacks,” the application said.
The application also said that his “severe medical conditions” render extradition to Indian detention facilities a “de facto" death sentence in this case.
The US Supreme Court denied Rana's petition for a writ of certiorari relating to his original habeas petition on January 21. The application notes that on that same day, newly-confirmed Secretary of State Marco Rubio had met with External Affairs Minister S Jaishankar.
When Prime Minister Narendra Modi arrived in Washington on February 12 to meet with Trump, Rana’s counsel received a letter from the Department of State, stating that “on February 11, 2025, the Secretary of State decided to authorise” Rana’s "surrender to India,” pursuant to the “Extradition Treaty between the United States and India”.
Rana’s Counsel requested from the State Department the complete administrative record on which Secretary Rubio based his decision to authorize Rana’s surrender to India.
The Counsel also requested immediate information of any commitment the United States has obtained from India with respect to Rana’s treatment. “The government declined to provide any information in response to these requests,” the application said.
It added that given Rana’s underlying health conditions and the State Department’s findings regarding the treatment of prisoners, it is very likely “Rana will not survive long enough to be tried in India".
During a joint press conference with Prime Minister Modi in the White House in February, President Donald Trump announced that his administration has approved the extradition of "very evil" Rana, wanted by Indian law enforcement agencies for his role in the 26/11 Mumbai terror attacks, "to face justice in India”.
A total of 166 people, including six Americans, were killed in the 2008 Mumbai terror attacks in which 10 Pakistani terrorists laid a more than 60-hour siege, attacking and killing people at iconic and vital locations in Mumbai.
