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 high respiratory failure, which according to the largest study of its kind to date.
The study, published in the journal Lancet Respiratory Medicine, monitored the incidence of delirium and coma in more than 2,000 Covid-19 patients admitted before April 28, 2020, to 69 intensive care units adult over 14 countries.
According to the scientists, led by those at Vanderbilt University Medical Center in the USA, the choice of sedative and lozenge medications on a family visit played a role in increasing severe brain dysfunction for the sufferers. those patients.
They said ICU delirium is associated with higher medical costs and an increased risk of ICU-related death and depression in the long run.
Nearly 82 percent of the patients in the study were comatose for a median of 10 days, and 55 percent were delirious for a three-day average.
The experts noted that a severe brain injury 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 put patients into a higher burden of brain damage.
However, they also noted that patient care factors appear to play an important role, some of which are related to pressures on health care with the pandemic.
Regarding Covid-19, the scientists believe that there has been a widespread omission of more recently proven clinical protocols that help in the monitoring of a depressive brain disorder that usually affects affecting many very severe patients.
“It is clear in our conclusions that many ICUs have returned to sedation practices that are not in line with best practice guidelines and we are left to consider the reasons,” Pun said.
“Early reports of Covid-19 suggested the need for a lack of lung regulation that included specific management methods including deep sedation. In the process, key preventive measures against malignancy were taken. brain part with the boards, “she said.
Analyzing patient characteristics from electronic health records, and care practices and conclusions from clinical evaluations, the scientists found that approximately 90 percent of patients surveyed in the study were admitted. mechanically invasive admission at some point in the hospital, and 67 percent on the day of ICU admission.
Patients receiving benzodiazepine sedative intake had a 59 percent higher risk for developing delirium, they said.
In contrast, patients who received a family visit had a 30 percent lower risk of delirium, the study noted.
“There is no reason to think that, since our study closed, the situation of these patients has changed,” said the study’s lead author, Pratik Pandharipande.
“Those long periods of brain depression are largely avoided. ICU teams above all need to return to milder levels of sedation for these patients, frequent wake-up and breathing tests, safe and meaningful personal transport and visits, “Pandharipande said.
