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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Kolkata, May 23: Alleging that the Union government was using central agencies to interfere in matters of the state, West Bengal Chief Minister Mamata Banerjee on Monday stated that the BJP-led dispensation was "bulldozing the country's federal structure".
Condemning the Centre's "attempts to interfere", she said that the "situation under the BJP-led government was more adverse than what it was under dictators such as Adolf Hitler, Joseph Stalin or Benito Mussolini".
She also said that central agencies "should be given autonomy" if democracy was to be protected.
"The BJP-led central government is using the central agencies to interfere into the state affairs. It is bulldozing the federal structure of the country. There is a Tughlaqi rule in force," she maintained, addressing a press conference at the state secretariat.
Banerjee, without taking names, said that the "agencies cannot work because there is no autonomy. The autonomy lay in the hands of two persons and the BJP. Such political interference was not prevalent during the time of Adolf Hitler, Joseph Stalin or Benito Mussolini".
Notably, the Bengal CM had long been accusing the BJP government at the Centre of using central agencies like the CBI, the ED to "harass" opponents, including those from her party.
The CBI is looking into a series of cases in Bengal involving violence, rape and smuggling, notable among them being incidents of post-poll violence after last year's assembly polls.
"I want the central government agencies to be given autonomy so that they can work impartially. There should not be any political vendetta. Let the government provide the agency employees with salary and nothing else. I am the first person to raise the issue... this has to be done if we want to save democracy in India," she insisted.
The CM, during the meeting, also criticised the alleged move by the Bihar Police to demolish huts in Malda on Friday.
"A team of police came from Bihar and demolished huts in bordering areas of Malda. You should have informed Bengal Police? What's happening in the country?"
The Bihar Police allegedly demolished nine huts in West Bengal's Malda district along the inter-state boundary and assaulted several residents, including women, when they protested the drive, officials have said.