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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I forgot that I can use saliva, but will use it from now on: RCB's Bhuvneshwar Kumar
Bengaluru, Apr 17 (PTI): Fast bowlers often have elephantine memory but Royal Challengers Bengaluru’s Bhuvneshwar Kumar rather sheepishly conceded that he has forgotten to use saliva to shine the ball despite the redrafted rules, and promised to make amends in the IPL match against Punjab Kings here on Friday.
In the run-up to this season’s IPL, the BCCI had lifted the ban on using saliva as a ball polishing agent after several captains favoured the move.
The saliva ban was enforced during the COVID-19 pandemic days as a precautionary measure.
Now, several skippers and quick bowlers have felt that it will revive the forgotten art of reverse swing, but Bhuvneshwar offered a different perspective.
“I forgot that I can use saliva. Yesterday when the (team) staff told me, I didn't know that I have to use it,” a sheepish Bhuvneshwar said on the eve of the match against Punjab Kings.
But now, there is a late realisation and he is open to experimentation.
“I am not sure if it will help or not, but now that I remember, definitely in tomorrow's match (vs PBKS) I will put some saliva and see if it helps or not," he said with a chuckle.
However, some of his contemporaries have eagerly latched on to the opportunity to purchase some reverse swing to keep the batters guessing.
Mitchell Starc of Delhi Capitals found a hint of reverse swing against Rajasthan Royals on Wednesday while homing in on the stumps with a series of yorkers in the 20th over and later in the Super Over.
Starc’s remarkable accuracy and the touch of reverse swing played a big role in DC eking out a Super Over win at the Arun Jaitely Stadium in the national capital.
“Reverse swing had completely gone away from cricket, whether it was red ball or white ball. Suddenly, if someone can execute 11 yorkers in 12 balls at a 145 (kmph) pace, then you have to give Starc the credit,” said RR’s Nitish Rana, who fell leg before to the Australian fast bowler.
Delhi’s skipper Axar Patel also offered some insight.
“Getting reverse swing is one thing, but executing it is very important. It was reversing, but at that time, under pressure, he (Starc) was executing it,” Patel said.
“I was just reminding him to be clear about the plans we made in the bowlers meeting. I was getting the same response: ‘Don’t worry, skip. I’ll do it',” he added.
rhaps, it’s time for Bhuvneshwar to do it as well.
