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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Modi should leverage his ties with world leaders to de-escalate war in West Asia: Omar Abdullah
Jammu (PTI): Jammu and Kashmir Chief Minister Omar Abdullah on Monday said India can play a meaningful role in de-escalation in West Asia, given Prime Minister Narendra Modi's strong relations with the warring countries and their neighbours.
He said Pakistan was leveraging ties with Iran and the United States, and that any effort towards ending the war should be welcomed.
"As I said in the House (Assembly), we would like the war to end as soon as possible. The role that the prime minister can play may not be possible for anyone else because of his good relations with all these countries," Abdullah told reporters on the sidelines of a function here.
He, however, said any escalation would not be easy to manage.
"Any such move by US President Donald Trump, despite the long history of Iran resisting external domination, would not be easy," the chief minister said.
Asked about Pakistan mediating in the war, he said, "I will simply say that if any country can play a role in preventing this war, no one should have any objection to it."
He added, "I will repeat what I said … our prime minister has good and close relations with all countries — whether it is Israel, the United States, Iran, or the countries around Iran. If those relationships can be used to make some progress and help ease the situation, it would be a good thing."
Abdullah said attacks by terror groups like Lashkar-e-Taiba and Jaish-e-Mohammed in India, as suggested by a report from the United States, are not unlikely.
Meanwhile, he asserted that any efforts to end the war, be it from Pakistan, must not be resisted.
"Pakistan is using its good relations with Iran and the United States to its advantage, and it has done so. How can we object to that? If that angle helps in stopping the war, would you want them not to act and let the war continue? We want the war to stop. If any country can play a role in that, it should. And if we can play an even better role, then we should do so," he said.
On unemployment in J-K, the chief minister said the issue cannot be resolved overnight, and government jobs alone are not the solution.
He stressed the need to explore alternative avenues, highlighting the importance of Mission Yuva in promoting entrepreneurship.
"Mission Yuva provides not just funding but also support in preparing DPRs and post-startup assistance, such as marketing. In just nine months, distributing Rs 1,000 crore and approving numerous schemes is a significant achievement," he said.
Abdullah credited the coordination between the government and Jammu and Kashmir Bank for the scheme's progress.
