Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, January 11, 2021

Acute Brain Dysfunction Prolonged in COVID-19 ICU Patients

   What that means is your doctor needs EXACT PROTOCOLS that prevent your need to be hospitalized as soon as you are diagnosed with COVID-19.

YOUR DOCTOR'S RESPONSIBILITY!

Do not tough it out at home.

 

Acute Brain Dysfunction Prolonged in COVID-19 ICU Patients

'COVID in the ICU is like a delirium factory'

A blurred photo of a covid-19 patient connected to various life saving equipment laying in a hospital bed

Acute brain dysfunction -- coma or delirium -- occurred frequently and was prolonged in critically ill COVID-19 patients, a large multicenter cohort study showed.

Of more than 2,000 COVID-19 ICU patients in 14 countries, 82% were comatose for a median of 10 days, reported Rafael Badenes, MD, PhD, of the University of Valencia in Spain, and co-authors in Lancet Respiratory Medicine. For the 55% showing delirium, the median duration was 3 days.

Acute brain dysfunction lasted a median of 12 days, twice what's usually seen with other ICU patients. Benzodiazepine use and family visits were identified as modifiable risk factors for COVID-19 delirium.

Prolonged acute brain dysfunction is "a harbinger of bad outcomes," said co-author Wes Ely, MD, of Vanderbilt University Medical Center in Nashville. Earlier research has shown that delirium duration is a predictor of mortality, length of stay, cost of care, and acquired dementia, he noted.

"What we're learning is that COVID in the ICU is like a delirium factory," Ely told MedPage Today. "It's a reason to have our hackles up and say OK, what are we going to do about it?"(Simple, you prevent it from going that far with EXACT PREVENTION PROTOCOLS. They don't exist yet. THEN CREATE THEM!)

The study looked at 2,088 COVID-19 patients admitted to 69 ICUs before April 28, 2020. Median patient age was 64, with median Simplified Acute Physiology Score (SAPS) II of 40 on admission; most were men (71.7%) and white (76.5%). Patients who were moribund or who had life-support measures withdrawn within 24 hours of ICU admission and those with pre-existing mental illness, neurodegenerative disorders, or brain damage were excluded.

Invasive mechanical ventilation was started on day one of ICU admission for two-thirds of patients (66.9%). Overall, 87.5% received mechanical ventilation at some point during their hospital stay and 63.1% were placed in the prone position for a median of 4 days. Median score on the Richmond Agitation–Sedation Scale while on invasive mechanical ventilation was –4.

Most patients received continuous sedative infusions while on mechanical ventilation: 64.0% of patients had benzodiazepines for a median of 7 days, and 70.9% had propofol for a median of 7 days.

Sedative benzodiazepine infusions (OR 1.59), antipsychotics (OR 1.59), invasive mechanical ventilation (OR 1.48), continuous opioid infusions (OR 1.39), restraint use (OR 1.32), and vasopressors (OR 1.25) each were associated with a higher risk of delirium the next day (all P≤0.04). Family interactions, including virtual visits, lowered delirium risk (OR 0.73, P<0.0001).

Nearly all the institutions (94%) in the study were teaching hospitals. Most (84%) increased their ICU bed capacity during the pandemic and 42% reported resource shortages, mostly of critical care providers, personal protective equipment, ventilators, ICU beds, and sedatives.

Before the COVID-19 pandemic, the reported incidence of new agitated delirium was up to 13% in adults with critical illness, with an overall prevalence of up to 20%, noted Valerie Page, MB BCh, of Watford General Hospital in England, in an accompanying editorial.

"The optimal approach to sedation in COVID-19 remains uncertain, although available evidence-based practice outside the context of COVID-19 should form the basis of the approach to delirium management," Page wrote. "As the severity of COVID-19 illness is modified with reduced viral load, reduction in risk factors, and earlier presentation, and more is understood about encephalopathy caused by COVID-19, clinicians might be able to safely manage the majority of these patients without the use of deep sedation."

ICU delirium rates had been declining before COVID-19, due in large part to protocols like the ABCDEF (A2F) bundle that re-evaluate sedation frequently, Ely noted. "We lost a lot of ground with COVID," he said. "Not since 2005 have we had this kind of benzodiazepine use."

The study had several limitations, the researchers observed. Routine care of severe COVID-19 patients may have changed after the study was completed. Neuroimaging data were not collected, nor was information about acute kidney injury. Sedative doses, sedation goals, and rationales for drug choices also were not assessed.

  • Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

There was no funding source for this study.

Researchers reported receiving NIH grants. The editorialist reported no competing interests.

 

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