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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New Delhi, May 16: The Centre directed Uttar Pradesh and Bihar on Sunday to prevent dumping of dead bodies in the Ganga and its tributaries, and focus on their safe disposal and a dignified cremation after corpses were seen floating in these rivers following a spurt in the number of coronavirus cases.
At a review meeting conducted on May 15-16, the Centre said dumping of dead bodies and partially burnt or decomposed corpses in the Ganga and its tributaries has recently been reported, which is "most undesirable and alarming".
"Namami Gange directs states to prevent dumping of dead bodies in the Ganga and focus on their safe disposal and providing support for ensuring dignified cremation," the Jal Shakti Ministry said.
The state pollution control boards were directed to monitor the water quality more frequently in consultations with the health departments.
The Central Pollution Control Board (CPCB) was assigned the task of overall monitoring, providing guidance to the state pollution control boards and taking up advanced analysis in the matter.
Support for cremation needs to be given top priority. Effective implementation of the government orders needs to be ensured. No loss of time should take place in implementation, the ministry said.
An advisory was issued by Rajiv Ranjan Mishra, Director General, National Mission for Clean Ganga, to the district magistrates, who are also the chairpersons of the district Ganga committees, on May 11.
This was followed up by a letter the next day to the chief secretaries to prevent the dumping of dead bodies in the river and ensure enforcement of the government guidelines on the cremation of COVID-19 victims.
The letter also advised the states to provide financial assistance as well as regulate the rates for the cremation or burial process.
On May 15, the steps taken in this regard in Uttar Pradesh and Bihar were reviewed at a meeting chaired Pankaj Kumar, Secretary, Ministry of Jal Shakti, and further action points were decided.
Highlighting the instructions already given, Kumar had called for expeditious action and underscored the need to give equal attention to such incidents in urban and rural areas along the Ganga and other rivers.
"Stopping of dumping of dead bodies as well as their safe disposal and protection of water quality have to be ensured on a war footing. After knowing the progress from the states, the CWC (Central Water Commission), the CPCB and the state pollution control boards would also be giving their feedback and action plans," he had said.
Mishra stated that the situation is being monitored and follow-up action is being taken in several districts such as Unnao, Kanpur rural, Ghazipur and Balia in Uttar Pradesh and Buxar and Saran in Bihar.
However, some cases have also been reported from other districts. He asked the state missions to keep an eye on the situation.
Mishra emphasised the need to strengthen enforcement, maintain vigil and take proactive action to facilitate and support the families for the cremation of the bodies and asked the state missions to specifically report on this.
"If needed, the project directors can assess and also give support to the district Ganga committees for this out of the NMCG funds available with them, while keeping the NMCG informed," he said.
Rajnish Dubey, Additional Chief Secretary, Urban Development, and Anurag Shrivastav, Principal Secretary, Jal Shakti and Project Director, State Ganga Mission, represented Uttar Pradesh in the meeting.
Shrivastava said all the district magistrates have been alerted about the issue and patrolling is being carried out to prevent dumping of dead bodies in the Ganga.
He also informed that 13 crematoria under Namami Gange, in addition to the existing ones, have been made available for the cremation of dead bodies.
It was informed that orders have been issued for financial support for cremations in urban areas. Dubey said similar orders for a financial support of Rs 5,000 have been issued by the Panchayati Raj department for rural areas and the SDRF and other forces have also been asked to carry out patrolling.
Anand Kishore, Principal Secretary, Urban Development and Project Director, State Ganga Mission, Government of Bihar, informed that it has been decided that the cremation or burial expenses of those dying due to COVID-19 will be borne by the state government.
He added that even if the deceased did not have a COVID-positive report but showed symptoms of the disease, the family will be offered this support.
He also said patrolling is being done to prevent further dumping of dead bodies in the river, especially in districts like Buxar and Saran (Chhapra).
CWC Chairman S K Halder informed that they are monitoring the flow and the water quality of the river through their stations and will further increase the frequency.
CPCB Member Secretary Prashant Gargava said the board has forewarned all water monitoring stations along the Ganga and her tributaries. The periodicity of testing the water quality has also been increased.
Debashree Mukherjee, Additional Secretary with the Jal Shakti Ministry, stated that besides an urgent assessment of the risks to the riverside communities by the pollution control boards, there is a need to raise awareness on the dos and don'ts as regards the use of river water and to prevent such incidents of dumping of bodies in the river.