COVID-19 Patients May Need More Time to Regain Consciousness
U.S. researchers who conducted a retrospective analysis of 795 mechanically ventilated COVID-19 patients in three large facilities in New York and Massachusetts have found that these patients often take days or even weeks to regain consciousness after being taken off the ventilator.
The patients in the study all had severe COVID-19. While some were already unconscious, most were placed in a medically induced coma while on the ventilator.
Among the 72% of patients who survived and ultimately regained consciousness before discharge, 25% took 10 days or longer to wake up fully. Ten percent took 23 days or longer.
Why do some patients take so long to recover consciousness? The researchers looked at various factors and found that the more low-oxygen episodes the patient had, the longer they took to regain consciousness. However, the investigators note that increasing ventilator support to raise blood oxygen levels typically will not help the situation since oxygen may not be reaching the bloodstream due to the condition of the lungs. Furthermore, prolonged ventilation can cause lung injury and exacerbate hypoxemia.
They believe the take-home message from their findings is that clinicians should proceed with caution when determining whether or not to withdraw life-sustaining therapy from these patients.
“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,” said co-senior author Dr. Jan Claassen, from Columbia University.
The study was published by the Annals of Neurology. Read More
Decision Support Tool Improves Pneumonia Care
A recent study out of Intermountain Healthcare suggests an electronic, open loop, clinical decision support system (ePNa) can lower mortality and result in better adherence to best practices for people who present to community hospital emergency departments with severe pneumonia.
The investigators implemented the system in 16 community hospitals between December 2017 and June 2019. During that time, the hospitals saw 6,848 pneumonia patients. The ePNa, which gathers information on key patient indicators and makes recommendations on best care practices, was used by bedside clinicians in 67% of cases.
The tool resulted in a 38% relative reduction in 30-day mortality, with the most significant reduction in mortality seen in patients admitted directly from the emergency department to the ICU. The researchers also saw a 17% increase in outpatient disposition, decreased ICU admission without safety concerns, and a lower mean time from emergency department admission to the start of a first antibiotic.
The study was published by the American Journal of Respiratory and Critical Care Medicine. Read More
Microphone System Eases Communication for Patients on NIV
ReddyPort has received a U.S. patent for a new positive pressure ventilation microphone system that can allow patients to communicate during treatment with noninvasive ventilation without removing their masks.
The ReddyPort Microphone and Controller, used with the ReddyPort Elbow, features an integrated speaker that uses digital signal processing to remove breathing noises and make the patient’s voice sound more natural.
ReddyPort CEO Tony Lair notes that effective verbal communication is essential for compliance with CMS, HHS, and Joint Commission directives to protect a patient’s right to manage their own care.
“ReddyPort Microphone is an essential device designed to empower patients with the ability to communicate to caregivers and family members,” he said. Read More
OSA Causes People to Age Faster; CPAP May Slow or Reverse It
Researchers who used age acceleration testing — a blood test that analyzes DNA and uses an algorithm to measure a person’s biological age — have found that obstructive sleep apnea (OSA) can accelerate aging.
The good news is treatment can slow that process or even reverse it.
The study was conducted among 16 adult nonsmokers with OSA and eight controls. Following a baseline blood test to assess age acceleration, also known as epigenetic aging, the OSA patients were treated with CPAP.
“Our results found that OSA-induced sleep disruptions and lower oxygen levels during sleep promoted faster biological age acceleration compared to the control group,” said study author Rene Cortese, PhD, from the University of Missouri School of Medicine. “However, the OSA patients who adhered to CPAP showed a deceleration of the epigenetic age, while the age acceleration trends did not change for the control group.”
The authors believe these results suggest that effective treatment for OSA can at least partially reverse biological age acceleration.
The study was published by the European Respiratory Journal. Read More
Long-COVID May Result in Small Airways Disease
University of Iowa researchers have found that long-COVID can involve the small airways.
The investigators performed inspiratory and expiratory CTs in 100 adults. These adults had confirmed COVID-19 and were still symptomatic more than 30 days after their initial diagnosis. Among the group, 67 did not require hospitalization and were dubbed the ambulatory group. However, 17 were hospitalized, and 16 were placed in the ICU.
Results from the CT scans revealed air trapping in many of the patients. Overall, air trapping affected a little over 25% of those in the ambulatory group and nearly 35% of the patients who had been hospitalized. Results from a control group found air trapping in only 7.2%.
Nine of the patients underwent imaging again more than 200 days after diagnosis, and eight of them had persistent air trapping, despite the severity of their initial bout with COVID-19. When the researchers performed a quantitative analysis of expiratory chest CT images, they found evidence of small airways disease in these patients.
The investigators plan to continue to follow the patients to see how they fare over a more extended period of time.
“If a portion of patients continues to have small airways disease, then we need to think about the mechanisms behind it,” said study author Alejandro P. Comellas, MD. “It could be something related to inflammation that’s reversible, or it may be something related to a scar that is irreversible, and then we need to look at ways to prevent further progression of the disease.”
The study was published by Radiology. Read More
Pulse Oximeter Sends Data Over the Cellular Network
Pulse oximetry is essential for monitoring oxygen levels in patients with chronic conditions like COPD, asthma, heart disease, and long-COVID. Remote patient monitoring keeps track of these levels in patients outside of the health care setting, but the technology used to transfer the data to clinicians is often cumbersome.
Smart Meter has developed what it believes to be the first cellular-connected pulse oximeter that transfers readings to clinicians without the need for the patient to connect the device to a computer or other device or use Bluetooth.
An AT&T IoT SIM card incorporated into the Smart Meter automatically sends the patient’s testing data over a secured AT&T network to the Smart Meter SmartRPM cloud. Health care providers can then access the data via a HIPAA-secure log-in to view and track the patient’s oxygen saturation in real-time. Read More
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Debbie Bunch is an AARC contributor who writes feature articles, news stories, and other content for Newsroom, the AARC website, and associated emailed newsletters. In her spare time, she enjoys reading, traveling, photography, and spending time with her children and grandchildren. Connect with Debbie by email or on AARConnect or LinkedIn.
