COVID-19 patients who are successfully weaned off a ventilator may take days, or even weeks, to regain consciousness, especially those who experienced episodes of hypoxemia while intubated, a new study shows.
"As we started to see the first patients waking up after successful COVID-19 ICU treatments, we also encountered many patients who remained comatose for days and weeks and then regained consciousness to become fully oriented," co-senior investigator Nicholas Schiff, MD, with NewYork-Presbyterian/Weill Cornell Medical Center in New York City, says in a news release.
The findings have immediate implications regarding life-sustaining therapies for unresponsive COVID-19 patients, the investigators note.
"In critical care medicine, one of our main tasks is to advise families about planning in the event a patient does not regain consciousness," said co-senior author Jan Claassen, MD, with New York-Presbyterian/Columbia University Irving Medical Center.
"Our findings suggest that for patients with severe COVID, the decision to withdraw life support shouldn't be based solely on prolonged periods of unconsciousness, as these patients may eventually recover," Claassen adds.
The study was published online March 7 in Annals of Neurology.
Slow Road Back
The researchers examined 795 intubated patients with severe COVID-19 at three medical centers in New York during the first wave of the pandemic (March-July 2020). All patients had impaired consciousness (Glasgow Coma Scale [GCS] motor score <6) on day 7 of intubation.
A total of 571 patients (72%) survived and regained consciousness.
The median time to recovery of consciousness was 30 days. One quarter of the patients recovered consciousness 10 days or longer after they stopped receiving ventilator support and 10% took 23 days or longer to recover.
Time to recovery of consciousness was associated with hypoxemia. The hazard ratio (HR) was 0.56 (95% CI, 0.46 - 0.68) with arterial partial pressure of oxygen (PaO2) ≤ 55 mm Hg and 0.88 (95% CI, 0.85 - 0.91) with a PaO2 ≤ 70 mm Hg.
Each additional day of hypoxemia decreased the odds of recovery of consciousness after accounting for confounding factors including sedation.
These findings were confirmed among patients without any imaging evidence of structural brain injury and in a non-overlapping cohort of 427 patients from the second wave of the pandemic (October-April 2021).
"These findings provide us with more accurate information to guide families who are deciding whether to continue life-sustaining therapy in unconscious COVID-19 patients," co-senior author Brian Edlow, MD, with Massachusetts General Hospital and Harvard Medical School in Boston, says in the news release.
"Encouragingly," adds Claassen, "our study shows that the vast majority of unconscious COVID patients recover consciousness, but it is important to consider that we did not look at the quality of recovery. That's something that should be the focus of long-term follow-up studies."
The study was supported by the James S. McDonnell Foundation (JSMF). Schiff, Claassen and Edlow have disclosed no relevant financial relationships.
Ann Neurol. Published online March 7, 2022. Abstract
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