Emery Brown, professor of medical engineering and neuroscience at Massachusetts Institute of Technology, likened the cognitive effects of coronavirus to those seen when patients awaken from deep sedation aftermajor surgery. 2023 Kaiser Family Foundation. Now, many COVID-19 patients are struggling with delirium and cognitive dysfunction. In many cases, sedation was prolonged and sometimes for several weeks; this was much longer than for common treatments requiring sedation, such as surgery. August 27, 2020. But it was six-and-a-half days before she started opening her eyes. Some of these patients, we wean them down off sedation, take the breathing tube out and right away they give us a thumbs up, or a few words, Nicholas Schiff, a neurologist at Weill Cornell Medicine in New York who specializes in treating disorders of consciousness, told the Washington Post. COVID-19 patients appear to need larger doses of sedatives while on a ventilator, and they're often intubated for longer periods of time than is typical for other diseases that cause pneumonia.. Additional anonymized data not available within the article or supplementary material are available to qualified researchers on reasonable request. But then Frank did not wake up. What are you searching for? After two weeks of no sign that he would wake up, Frank blinked. During the following weeks, her level of consciousness improved, and she eventually started obeying commands adequately with her eyes and facial musculature in combination with a flaccid tetraparesis. LULU. Boston, Accuracy and availability may vary. ), Neurology (A.A.A.C.M.W. Frank did not die. During the early outbreak of the pandemic, it was unclear how to best treat patients with extensive damage to their lungs and subsequentacute respiratory distress syndrome (ARDS). Heres what we ask: You must credit us as the original publisher, with a hyperlink to our khn.org site. Web page addresses and e-mail addresses turn into links automatically. Low oxygen levels, due to the viruss effect on the lungs, may damage the brain. Their respiratory systems improved, but they were comatose.. To mitigate exposure to Covid-19, Dr. NOTE: The first author must also be the corresponding author of the comment. The Washington Post: @mbebinger, By Martha Bebinger, WBUR For the sickest COVID-19 patients, getting on a ventilator to help them breathe can be a life-saving process. Patients coming off a ventilator typically take hours, even a day to wake up as the drugs that help them tolerate the machine wear off. Its a devastating experience.. ), Prolonged Unconsciousness Following Severe COVID-19. Motor reactions with the limbs occurred in the last phase. According to the South China Morning Post, doctors at Hong Kong's Hospital Authority have noted some COVID-19 patients experience drops of 20 to 30 percent in lung function. Schiff said all of his colleagues in the fieldare seeing patients with prolonged recovery, though the incidence of the cases is still unknown. Some patients may be on a ventilator for only a few hours or days, but experts say COVID-19 patients often remain on the ventilators for 10 days or more. Critically ill COVID patient survives after weeks on ventilator | 9news.com Coronavirus After weeks on a ventilator, this COVID patient's family worried he would die. The sedative midazolam was stopped on ICU day 10, and the sedative propofol was stopped on ICU day 14. A brain MRI was subsequently performed on ICU day 26, which showed a diffuse white matter abnormalities (figure). Lockdowns, school closures, mask wearing, working from home, and ongoing social distancing have spurred profound economic, social, and cultural disruptions. It was a long, difficult period of not just not knowing whether he was going to come back to the Frank we knew and loved, said Leslie Cutitta. EDLOW: So there are many different potential contributing factors, and the degree to which each of those factors is playing a role in any given patient is something that we're still trying to understand. This has prompted physicians and researchers at Massachusetts General Hospital to study the effects of sedation on neurological outcomes in COVID-19 patients. The persistent, coma-like state can last for weeks. BEBINGER: Take Frank Cutitta as an example. ;lrV) DHF0pCR?7t@ | Because her consciousness level did not improve beyond opening of her eyes, the concentrations of midazolam and its metabolites were measured and were undetectable in blood on ICU day 18. 66 0 obj <> endobj We appreciate all forms of engagement from our readers and listeners, and welcome your support. Subsequently, 1 to 17 days later, patients started to obey commands for the first time, which always began with facial musculature such as closing and opening of the eyes or mouth. Prolonged or persistent comas are just one area of research, but one getting a lot of attention. (See "COVID-19: Epidemiology, clinical features, and prognosis of the critically ill adult", section on 'Length of stay' .) You're more likely to have hypoxic injury in people who needed prolonged ventilation regardless of source, notes Dr. Mukerji. Their candid and consistent answer was: We dont know. Schiff told the paper many of the patients show no sign of a stroke. As COVID-19 patients fill ICUs across the country, it's not clear how long hospital staff will wait beyond that point for those patients who do not wake up after a ventilator tube is removed. Survival outcomes were outlined for 189 consecutive COVID-19 patients who had received ECMO support at 20 institutions at the time of the analysis: 98 died on ECMO or within 24 hours of . You can support KHN by making a contribution to KFF, a non-profit charitable organization that is not associated with Kaiser Permanente. WHO now says asymptomatic spread of coronavirus is 'very rare', doctors began to notice that blood clots could be another troubling complication. The researchers are sharing their data to determine the cause of prolonged coma in COVID-19 patients, find treatments and better predict which patients might eventually recover, given enough time and treatment. "We didn't see a large number of clots to speak to the amount of hypoxic injury," says Dr. Mukerji. From what they could tell, there was no brain damage, Leslie Cutitta said. Error: Please enter a valid email address. When the patient develops a respiratory failure due to a lung infection related to covid-19, several things have to be done. ), Neurology (C.I.B., A.M.T. ", Learn more about the Department of Neurology, Learn more about research in the Department of Neurology, Director, Neuroscience Statistics Research Lab, Massachusetts General Hospital, Anesthesiologist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Neurologist, Massachusetts General Hospital, Primary Investigator, Delirium Lab, Massachusetts General Hospital, Assistant Professor of Neurology, Associate Director of the Neuro-infectious Diseases Unit. I thought she had suffered a massive stroke. Go to Neurology.org/N for full disclosures. Others with milder cases of COVID-19 recover in three or four days. We are committed to providing expert caresafely and effectively. Explore fellowships, residencies, internships and other educational opportunities. Obeying commands (mostly through facial musculature) occurred between 8 and 31 days after cessation of sedatives. 2023 FOX News Network, LLC. Many hospitals use 72 hours, or three days, as the period for patients with a traumatic brain injury to regain consciousness before advising an end to life support. Ancillary investigations (table 1) showed a severe critical illness polyneuropathy. The Effects of Sedation on Brain Function in COVID-19 Patients Although treatment for those with COVID-19 has improved, concerns about neurological complications continue to proliferate. Two months after first being diagnosed with Covid-19, she found her heart would start racing without warning. You will probably stay awake, but may not be able to speak. Some families in that situation have decided to remove other life supports so the patient can die. She was admitted to the hospital for oxygen therapy. There is data to suggest there's these micro-bleeds when looking at magnetic resonance imaging, but that doesn't speak to whether or not these micro-clotsresult in hypoxic changes, says Dr. Mukerji. L CUTITTA: We would all just be pressing the phone to our ears, trying to catch every word. To find COVID-19 vaccine locations near you: Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233. KHN is an editorially independent program of KFF (Kaiser Family Foundation). Legal Statement. "Some fat-soluble sedatives, such as propofol, may prolong anesthetization and contribute to patients not waking up," says Dr. Brown. The ripple effects of COVID-19 have reached virtually all aspects of society. About 40% of elderly patients and up to one-third of children have lingering confusion and thinking problems for several days after surgery and anesthesia. And then, on May 4, after two weeks with no signs that Frank would wake up, he blinked. Meet Hemp-Derived Delta-9 THC. But doctors across the U.S. and in other countries have noted a troubling phenomenon associated with some COVID cases: Even after extubation, some patients remain unconscious for days, weeks or longer. 5: They can pinpoint the site of the pain. It was learned that an often-helpful option was to keep critically ill patients sedated for prolonged periods of time until they were able to breathe on their own. He didnt have a lot of them at that point, but it was just amazing, absolutely amazing.. Mass General researchers will continue improving neurological outcomes while identifying the impact of COVID-19on the brain. They assess patients, make diagnoses, provide support for . Here are more sleep tips: Keep a normal daily routine: "If you're working from home, keep the same schedule as if you were going to work," Hardin said. Leslie and Frank Cutitta have a final request: Wear a mask. "The fundamental response to COVID-19 is inflammation," says Dr. Brown. All six had evidence of extensive brain pathologies at the time of death. A 41-year-old woman with a medical history of diabetes mellitus, hypothyroidism, and severe obesity (body mass index 43.5 kg/m2) presented to the emergency department with a 3-day history of respiratory symptoms and bilateral infiltrates on her chest x-ray. Edlow says some patients have COVID-related inflammation that may disrupt signals in the brain. MA 6 . In patients with coronavirus disease 2019 (COVID-19) who are admitted to the intensive care unit (ICU) for respiratory distress, an encephalopathy, most notably in the form of delirium, occurs in up to 84%.1 Brain MRI studies in patients in the ICU with COVID-19, including those with prolonged comatose state, reported varying degrees of MRI abnormalities, although few to no details were reported on the clinical picture, course, and prognosis of prolonged unconsciousness in such patients.2 Here, we report a case series of patients with COVID-19 admitted to the ICU for respiratory failure who, after cessation of sedatives, remained unconscious for longer than expected periods. Frank Cutitta credits the Mass General doctors and nurses, saying they became his advocates. Do not be redundant. Dr. Brown notes that all werelikely contributing to these patients not waking up., A Missing Link Between Coronavirus and Hypoxic Injury. Brown said faster recoveries could be possible if doctors lower the dosages of sedatives during mechanical ventilation. SARS-CoV-2 readily infects the upper respiratory tract and lungs. Neurological symptoms such as loss of smell, confusion and headaches have been reported over the course of the pandemic. "If we accelerate our emphasis on trying to use neuroscience in a more principled way, it will pay dividends for these ICU patients, whether they are being treated for COVID-19 or otherwise. Leslie Cutitta said yes, twice, when clinicians from Massachusetts General Hospital in Boston called asking whether she wanted them to take and then continue extreme measures to keep her husband, Frank Cutitta, alive. Leslie wrestled with the life doctors asked her to imagine. Do remain quietly at home for the day and rest. His mother, Peggy Torda-Saballa said her son was healthy before he was. BEBINGER: And prompted more questions about whether to continue life support. There are also patients who have extended hospital stays, followed by an even longer recovery period in a long-term care facility. All rights reserved. Whatever caused his extended period of unconsciousness cleared. "There's no consistent report that shows direct central nervous system infection, looking atPCRassay in intubated patients with prolonged sedation.". Neurologists and neuroscientists at Massachusetts General Hospital are working to understand the effects of that long-term sedation on patients' neurological function.