TY - JOUR
T1 - Prolonged Unconsciousness is Common in COVID-19 and Associated with Hypoxemia
AU - Waldrop, Greer
AU - Safavynia, Seyed A.
AU - Barra, Megan E.
AU - Agarwal, Sachin
AU - Berlin, David A.
AU - Boehme, Amelia K.
AU - Brodie, Daniel
AU - Choi, Jacky M.
AU - Doyle, Kevin
AU - Fins, Joseph J.
AU - Ganglberger, Wolfgang
AU - Hoffman, Katherine
AU - Mittel, Aaron M.
AU - Roh, David
AU - Mukerji, Shibani S.
AU - Der Nigoghossian, Caroline
AU - Park, Soojin
AU - Schenck, Edward J.
AU - Salazar-Schicchi, John
AU - Shen, Qi
AU - Sholle, Evan
AU - Velazquez, Angela G.
AU - Walline, Maria C.
AU - Westover, M. Brandon
AU - Brown, Emery N.
AU - Victor, Jonathan
AU - Edlow, Brian L.
AU - Schiff, Nicholas D.
AU - Claassen, Jan
N1 - Funding Information:
The authors thank the nurses, attendings, fellows, residents, advanced practice providers, pharmacists, respiratory therapists, and other health care personnel at New York Presbyterian Hospital/Columbia University Irving Medical Center (CUIMC), Massachusetts General Hospital (MGH), and New York Presbyterian Hospital/Weill Cornell Medical College (WCMC) for taking care of these very sick patients and their overall support of this project.
Publisher Copyright:
© 2022 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.
PY - 2022/6
Y1 - 2022/6
N2 - Objective: The purpose of this study was to estimate the time to recovery of command-following and associations between hypoxemia with time to recovery of command-following. Methods: In this multicenter, retrospective, cohort study during the initial surge of the United Statesʼ pandemic (March–July 2020) we estimate the time from intubation to recovery of command-following, using Kaplan Meier cumulative-incidence curves and Cox proportional hazard models. Patients were included if they were admitted to 1 of 3 hospitals because of severe coronavirus disease 2019 (COVID-19), required endotracheal intubation for at least 7 days, and experienced impairment of consciousness (Glasgow Coma Scale motor score <6). Results: Five hundred seventy-one patients of the 795 patients recovered command-following. The median time to recovery of command-following was 30 days (95% confidence interval [CI] = 27–32 days). Median time to recovery of command-following increased by 16 days for patients with at least one episode of an arterial partial pressure of oxygen (PaO2) value ≤55 mmHg (p < 0.001), and 25% recovered ≥10 days after cessation of mechanical ventilation. The time to recovery of command-following was associated with hypoxemia (PaO2 ≤55 mmHg hazard ratio [HR] = 0.56, 95% CI = 0.46–0.68; PaO2 ≤70 HR = 0.88, 95% CI = 0.85–0.91), and each additional day of hypoxemia decreased the likelihood of recovery, accounting for confounders including sedation. These findings were confirmed among patients without any imagining evidence of structural brain injury (n = 199), and in a non-overlapping second surge cohort (N = 427, October 2020 to April 2021). Interpretation: Survivors of severe COVID-19 commonly recover consciousness weeks after cessation of mechanical ventilation. Long recovery periods are associated with more severe hypoxemia. This relationship is not explained by sedation or brain injury identified on clinical imaging and should inform decisions about life-sustaining therapies. ANN NEUROL 2022;91:740–755.
AB - Objective: The purpose of this study was to estimate the time to recovery of command-following and associations between hypoxemia with time to recovery of command-following. Methods: In this multicenter, retrospective, cohort study during the initial surge of the United Statesʼ pandemic (March–July 2020) we estimate the time from intubation to recovery of command-following, using Kaplan Meier cumulative-incidence curves and Cox proportional hazard models. Patients were included if they were admitted to 1 of 3 hospitals because of severe coronavirus disease 2019 (COVID-19), required endotracheal intubation for at least 7 days, and experienced impairment of consciousness (Glasgow Coma Scale motor score <6). Results: Five hundred seventy-one patients of the 795 patients recovered command-following. The median time to recovery of command-following was 30 days (95% confidence interval [CI] = 27–32 days). Median time to recovery of command-following increased by 16 days for patients with at least one episode of an arterial partial pressure of oxygen (PaO2) value ≤55 mmHg (p < 0.001), and 25% recovered ≥10 days after cessation of mechanical ventilation. The time to recovery of command-following was associated with hypoxemia (PaO2 ≤55 mmHg hazard ratio [HR] = 0.56, 95% CI = 0.46–0.68; PaO2 ≤70 HR = 0.88, 95% CI = 0.85–0.91), and each additional day of hypoxemia decreased the likelihood of recovery, accounting for confounders including sedation. These findings were confirmed among patients without any imagining evidence of structural brain injury (n = 199), and in a non-overlapping second surge cohort (N = 427, October 2020 to April 2021). Interpretation: Survivors of severe COVID-19 commonly recover consciousness weeks after cessation of mechanical ventilation. Long recovery periods are associated with more severe hypoxemia. This relationship is not explained by sedation or brain injury identified on clinical imaging and should inform decisions about life-sustaining therapies. ANN NEUROL 2022;91:740–755.
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U2 - 10.1002/ana.26342
DO - 10.1002/ana.26342
M3 - Article
C2 - 35254675
AN - SCOPUS:85128424717
VL - 91
SP - 740
EP - 755
JO - Annals of Neurology
JF - Annals of Neurology
SN - 0364-5134
IS - 6
ER -