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 vetoes Palestinian bid to gain statehood at the United Nations
United Nations, Apr 19: The US has vetoed a resolution in the UN Security Council on the latest Palestinian bid to be granted full membership of the United Nations, an outcome lauded by Israel but criticised by Palestine as “unfair, immoral, and unjustified".
The 15-nation Council voted on a draft resolution Thursday that would have recommended to the 193-member UN General Assembly “that the State of Palestine be admitted to membership in the United Nations.”
The resolution got 12 votes in its favour, with Switzerland and the UK abstaining and the US casting its veto.
To be adopted, the draft resolution required at least nine Council members voting in its favour, with no vetoes by any of its five permanent members - China, France, Russia, the United Kingdom and the United States.
Palestinian attempts for recognition as a full member state began in 2011. Palestine is currently a non-member observer state, a status that was granted in November 2012 by the UN General Assembly.
This status allows Palestine to participate in proceedings of the world body but it cannot vote on resolutions. The only other non-member Observer State at the UN is the Holy See, representing the Vatican.
Israel’s Foreign Minister Israel Katz praised the US for vetoing what he called a “shameful proposal.”
“The proposal to recognise a Palestinian state, more than 6 months after the largest massacre of Jews since the Holocaust and after the sexual crimes and other atrocities committed by Hamas terrorists was a reward for terrorism”, Katz wrote on X, after the US veto.
US Ambassador Robert Wood, Alternative Representative for Special Political Affairs, said in the explanation of the vote at the Security Council meeting on Palestinian membership that Washington continues to strongly support a two-state solution.
“It remains the US view that the most expeditious path toward statehood for the Palestinian people is through direct negotiations between Israel and the Palestinian Authority with the support of the United States and other partners,” he said.
“This vote does not reflect opposition to Palestinian statehood, but instead is an acknowledgement that it will only come from direct negotiations between the parties.”
Wood said there are “unresolved questions” as to whether Palestine meets the criteria to be considered a State.
“We have long called on the Palestinian Authority to undertake necessary reforms to help establish the attributes of readiness for statehood and note that Hamas - a terrorist organisation - is currently exerting power and influence in Gaza, an integral part of the state envisioned in this resolution,” he said, adding that “For these reasons, the United States voted “no” on this Security Council resolution.”
Wood noted that since the October 7 attacks last year against Israel by Hamas, US President Joe Biden has been clear that sustainable peace in the region can only be achieved through a two-state solution, with Israel’s security guaranteed.
"There is no other path that guarantees Israel’s security and future as a democratic Jewish state. There is no other path that guarantees Palestinians can live in peace and with dignity in a state of their own. And there is no other path that leads to regional integration between Israel and all its Arab neighbours, including Saudi Arabia,” he said.
The Palestinian Authority President, Mahmoud Abbas, sharply criticised the US veto, saying that it was “unfair, immoral, and unjustified, and defies the will of the international community, which strongly supports the State of Palestine obtaining full membership in the United Nations.”
Riyad Mansour, Permanent Observer of the State of Palestine, said that “our right to self-determination has never once been subject to bargaining or negotiation.
“Our right to self-determination is a natural right, a historic right, a legal right. A right to live in our homeland Palestine as an independent state that is free and that is sovereign. Our right to self-determination is inalienable...,” he said.
Getting emotional and choking up as he made the remarks, Mansour said that a majority of the Council members “have risen to the level of this historic moment” and have stood “on the side of justice, freedom and hope.”
He asserted that Palestine’s admission as a full member of the UN is an “investment in peace.”
On April 2, 2024, Palestine again sent a letter to UN Secretary-General Antonio Guterres requesting that its application for full UN membership be considered again.
For a State to be granted full UN membership, its application must be approved both by the Security Council and the General Assembly, where a two-thirds majority of the members present and voting is required for the State to be admitted as a full member.
Earlier in the day, Guterres, in his remarks to a Council meeting on the Middle East, warned that the region is on a “knife edge”.
“Recent escalations make it even more important to support good-faith efforts to find lasting peace between Israel and a fully independent, viable and sovereign Palestinian state,” Guterres said.
“Failure to make progress towards a two-state solution will only increase volatility and risk for hundreds of millions of people across the region, who will continue to live under the constant threat of violence,” he said.
The UN, citing the Ministry of Health in Gaza, said that between October 7 last year and April 17, at least 33,899 Palestinians have been killed in Gaza and 76,664 Palestinians injured. Over 1,200 Israelis and foreign nationals, including 33 children, have been killed in Israel, the vast majority on October 7.
As of April 17, Israeli authorities estimate that 133 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies are withheld.
