Report emphasizes delirium, potency in sedated ICV COVID-19 patients
In COVID-19 patients admitted to intensive care units (ICUs) early in the pandemic, 82% were in a comatose state at some point and 55% had delirium, with recitation a Lancet a study published late last week. Previous studies have linked ICU delirium to higher costs, increased risk of death, and long-term depression.
Patient data from 14 countries showed that 54.9% of 2,088 patients admitted to ICUs by April 28, 2020, developed delirium for a median of 3 days and 81.6% were in a coma for a median of 10 days.
“This is double what has been seen in non-COVID ICU patients,” Brenda Pun, DNP, RN, of Vanderbilt University Medical Center, co-author of the study, said in a Vanderbilt news release. “It is clear from our findings that many ICUs have returned to sedation practices that are not in line with best practice guidelines,” Pun said.
Sixty-four percent of patients received benzodiazepines and 70.9% were given propofol, each for a median of 7 days. Patients who experienced delirium or coma on one day were 17.84 and 6.34 times more likely to develop the next day, respectively.
Severe brain damage – defined as either coma or delirium – has occurred for a median of 12 days.
While benzodiazepine sedative ingestions were associated with a 59% higher risk of delirium, family physical or digital presence was associated with a 27% reduction.
Other factors associated with severe brain damage included antipsychotic use (odds ratio) [OR] 1.59), aggressive mechanical ventilation (OR, 1.48), persistent opioid infusions (1.39), smoking or alcohol abuse (1.37), restraint use (1.32), vasopressor use (1.25), old age (1.13), and Acute Simply Higher Psychological Score Score II (1.17), which measures the likelihood of ICU mortality.
“Although SARS-CoV-2 infection was originally thought to contribute directly to brain symptoms, neurological effects are more likely to be caused indirectly by factors such as low blood oxygen levels, coagulopathy. , exposure to sedative and analgesic drugs, isolation, and immobility, ”the researchers wrote.
Scientists need to investigate the reasons behind the use of sedation with COVID-19, writes Valeria Page, MB BCh, in a Lancet recitation. “To what extent was patient acupuncture or the use of muscle tissue, both in need of deep sedation? What was the impact of a reduction in trained staff? ? 30% of ICUs lacked personal protective equipment for care providers, which may have only influenced the decision not to reduce patient sedation. “
January 8th Lancet study
Jan 8 Vanderbilt University press release
January 8th Lancet recitation
Oseltamivir early for severe flu associated with reduced re-admission to hospital
A new study from Australia published in the International Journal of Infectious Diseases showing early administration with the antiviral drug oseltamivir (Tamiflu) was associated with a reduction in 30-day relapse and length of hospital stay, but not with 30-day mortality in hospitalized patients with influenza.
The retrospective study was based on the results of adult patients who administered oseltamivir either within 48 hours or after 48 hours in the hospital due to severe colds. The 1,828 patients were admitted to two major tertiary hospitals in South Australia from January 2016 to March 2020.
The average age of patients was 66.4, of which 52.9% were women. Patients also had a high burden of comorbidity, comprising 32.4% with a history of chronic lung disease. The overall mortality rate was 4.3%, and the readmission rate was 13.5%.
Both 30-day relapse and mixed outcome of relapse or 30-day death were significantly reduced among patients who received oseltamivir (P.<0.05) less than 48 hours later compared with the delayed treatment group, the authors reported.
“The beneficial effect of Oseltamivir in reducing relapse may be related to a reduction in the incidence of secondary complications of influenza such as bacterial infection or less exacerbation of chronic medical conditions,” he said. -the authors closed.
January 9th Intl J Infect Dis study
H5N8 bird flu affects chickens in Northern Ireland, Hungary, and India
Northern Ireland and Hungary are the latest countries in Europe to report highly pathogenic H5N8 avian influenza in chickens, according to the latest reports from the World Organization for Animal Health (OIE) .
The Northern Ireland uprising began on December 27 at a cover farm in Clough, the first strain-strained hen in the country, which is part of the United Kingdom, since 2017. The virus killed 197 32,347 eun.
Hungary reported two H5N8 outbreaks at commercial turkey farms in northwestern Kamarom-Esztergom County, the first involving the pressure from June 2020. The events began on January 4, and , together, the virus killed 150 of 84,572 birds. Hungarian officials also said they found the H5N8 virus in an egret that was found dead on Dec. 22 at a nature park in the same county.
In other developments, India, where the government recently reported an outbreak of avian flu in four states, reported five H5N8 incidents at poultry farms in the state of Kerala, starting from December 21 to Dec. 28. Among the events, the virus killed 25,265 of 82,952 susceptible birds.
Jan 8 OIE Report on H5N8 in Northern Ireland
Jan 11 OIE report on H5N8 in Hungarian chickens
Jan 11 OIE report on H5N8 in Hungarian wild birds
Jan 9 OIE Report on H5N8 in India