A worldwide study carried out on more than 2,000 Covid-19 patients admitted to the intensive care unit at the start of the pandemic establishes a link between the prescription of sedatives, the limitation of family visits and more serious acute brain dysfunction.
Featured in The Lancet Respiratory Medicine, the study was conducted by researchers at the Vanderbilt University Medical Center (USA), in coordination with Spanish researchers. This is by far the most significant research of its kind conducted to date on the incidence of delirium and coma.
Patients were admitted by April 28, 2020 to 69 adult intensive care units. The research focused on the phases of “delirium” of these patients, plunged into a coma. Some 82% of patients in this observational study were comatose for a median of 10 days, and 55% were delirious for a median of three days. Acute brain dysfunction (coma or delirium) lasted an average of 12 days.
“This is double what is observed in non-comatose patients in intensive care”, underlines Brenda Pun, who co-directed the study with Pr Rafael Badenes, from the University of Valencia in Spain. . The authors of this work believe that the disease processes of Covid-19 may predispose patients to a greater burden of acute brain dysfunction.
Neglected health protocols in the emergency of the pandemic
But above all, the study shows that the care given to patients seems to be the result of pressures exerted by the pandemic. Indeed, deep sedation, widespread use of benzodiazepine infusions (benzodiazepine is a nervous system depressant), immobilization and family isolation ignore new clinical protocols that help prevent acute brain dysfunction in critically ill patients, doctors point out.
By consulting the electronic medical records of patients, the researchers were able to observe that 88% of them had been subjected to invasive mechanical ventilation at some point during their hospitalization, including 67% on the day of their admission to intensive care. . Patients receiving benzodiazepine sedative infusions also had a 59% increased risk of developing delirium, compared to those receiving family visits and the risk was reduced by 30%.
“Many hospitals in our sample reported a shortage of critical care providers knowledgeable about best practices. The shortage of sedatives raised concerns, and early reports from Covid-19 patients suggested that the observed pulmonary dysfunction necessitated unique management techniques including deep sedation, so key preventative measures against acute brain dysfunction have been somewhat overlooked,” says Brenda Pun.
“These prolonged periods of acute brain dysfunction are largely preventable. Our study sounds the alarm: as we enter the second and third waves of Covid-19, critical care teams must first and foremost return to sedation levels lighter for these patients, frequent waking and breathing trials, mobilization, and safe in-person or virtual visits,” the researchers conclude.
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