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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Man arrested with Rs 2.54-crore heroin in Mumbai
Mumbai (PTI): Police have arrested a man and seized over 500 grams of heroin worth Rs 2.54 crore in the illicit market from him in Mumbai, officials said on Friday.
The police's Anti-Narcotics Cell (ANC) made the drug seizure in Santacruz in the western suburbs. The operation was conducted by the Kandivali unit of the ANC on Thursday as part of a special crackdown against drug trafficking in the area, they said.
Acting on specific inputs, an ANC team conducted a raid in Santacruz (East) and intercepted a man. During a search, the team recovered 508 grams of high-grade heroin from his possession, an official said.
The seized contraband, a highly addictive, opioid drug derived from morphine, is estimated to be worth Rs 2.54 crore in the international market, he informed.
Following the seizure, a case was registered against the man under relevant sections of the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985, and he was formally placed under arrest in the early hours of Friday.
The police are currently investigating the source of the drug and trying to identify the intended recipients of the consignment, he said.
