Reasons Patients on Ventilators May Regain Consciousness Weeks Later

A recent study reveals that while it may take some time for COVID patients who are taken off ventilators to regain consciousness, this is not necessarily a bad portent.

As a patient begins to recover, the body may be attempting to protect the brain from oxygen deprivation.

The researchers recommended that while establishing a patient’s prognosis, doctors consider these prolonged healing timeframes.

Dr. Nicholas Schiff, co-director of the Consortium for the Advanced Study of Brain Injury at Weill Cornell Medicine in New York City and a study co-senior author, noted that the delayed recoveries in COVID-19 patients “are very much like the few cases we’ve recorded in earlier research.”

According to a Weill Cornell news release, “In our new research, we suggest a mechanism to explain what we’re finding in both categories of patients.”

These delays were initially noted by Schiff and his colleagues in comatose cardiac arrest patients more than ten years ago. These individuals underwent chilling therapy to lessen brain damage brought on by a blood flow interruption. After 37 days, one patient who was 71 years old awoke, but she later made a nearly full recovery.

When COVID-19 patients were removed off ventilators, Schiff, a neurologist at New York-Presbyterian/Weill Cornell Medical Center, observed comparable delayed awakenings.

A quarter of patients who were ventilated successfully need 10 days or more to regain consciousness. If they had been on the ventilator for a longer period of time, they would have needed more oxygen.

Animals that can survive for days or weeks without oxygen provide evidence that the patients’ brains may be defending themselves throughout these times.

Schiff noted that painted turtles, who may go without oxygen for up to five months under ice in the winter, experience this. They accomplish this by turning on the same inhibitory system in the brain that anaesthetics target.

Dr. Emery Brown, co-author of the study and a professor of anaesthesia at Harvard Medical School, said, “These observations may offer new insights into the mechanisms of how certain anaesthetics produce unconsciousness, as well as new approaches for ICU sedation and for fostering recovery from disorders of consciousness.”

Patients who fail to regain consciousness for a prolonged period of time frequently receive the recommendation from doctors to remove life support. For people with heart disease, that is usually limited to 14 days or less. For COVID-19 patients, there are no recommendations.

According to the researchers, doctors should refrain from making unfavourable predictions about their patients’ chances of recovery as long as they do not suffer brain damage.

The results were released in the Proceedings of the National Academy of Sciences on November 7.

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More information about ventilator use during the COVID-19 pandemic is available from the US Centers for Disease Control and Prevention.

SOURCE: A news release from Weill Cornell Medicine

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