JOSEPH GIACINO: We need to really go slow because we are not at a point where we have prognostic indicators that approach the level of certainty that we should stop treatment because there is no chance of meaningful recovery.īEBINGER: Take Frank Cutitta as an example. Joseph Giacino, who directs neuropsychology at Spaulding Rehabilitation Hospital, says he's worried hospitals are using that 72-hour model now with COVID patients who may need more time. After that, doctors often begin conversations with the family about ending life support. Many hospitals wait 72 hours, or three days, for patients with a traumatic brain injury to regain consciousness. But how many of those actually took a long time to wake up? We don't have numbers on that yet.īEBINGER: Claassen says he's guardedly optimistic about recovery for these patients, but there's growing concern about whether hospitals overwhelmed by COVID patients are giving them enough time to recover. JAN CLAASSEN: In our experience, approximately every fifth patient that was hospitalized was admitted to the ICU and had some degree of disorders of consciousness. Jan Claassen, a neurologist at New York's Columbia Medical Center, is part of the research group working to answer that question. And in some patients, COVID triggers blood clots that cause strokes.ĮDLOW: So there are many different potential contributing factors, and the degree to which each of those factors is playing a role in any given patient is something that we're still trying to understand.īEBINGER: They also want to know how many COVID patients end up in this prolonged sleeplike condition. Edlow says some patients have COVID-related inflammation that may disrupt signals in the brain. They're sharing data with the goal of figuring out which patients recover, what treatment helps and why some patients are not waking up.ĮDLOW: There's several potential reasons for this, one of which is that we are having to administer very large doses of sedation to keep people safe and comfortable while they're on the ventilator.īEBINGER: Frank, for example, was on a lot of sedatives for a long time - 27 days on a ventilator. This spring, as Edlow watched dozens of patients linger in this unconscious state, he reached out to colleagues in New York to form a research group. Brian Edlow is a critical care neurologist at Mass General.īRIAN EDLOW: Because this disease is so new and because there are so many unanswered questions about COVID-19, we currently do not have reliable tools to predict how long it's going to take any individual patient to recover consciousness.īEBINGER: Or what their mental state might be if or when they do. L CUTITTA: If this looks like Frank's not going to return mentally and he's going to be hooked up to a dialysis machine for the rest of his life in an acute long-term care facility, is that something that you and he could live with?īEBINGER: Every day, sometimes several times a day, Leslie Cutitta would ask Frank's doctors, what's going on inside his brain? Why is this happening? The candid answer was, we don't know.ĭr. Leslie wrestled with the life doctors asked her to imagine. It was very tough, very tough.īEBINGER: And prompted more questions about whether to continue life support. LESLIE CUTITTA: It was a long, difficult period of just not knowing whether he was really going to come back to the Frank we knew and loved. After nearly a month, Frank's lungs had recovered enough to come off a ventilator. MARTHA BEBINGER, BYLINE: While Frank Cutitta lay in an ICU at Massachusetts General Hospital, doctors called his wife Leslie Cutitta twice to have what she remembers as the end-of-life conversation. From WBUR in Boston, Martha Bebinger has this story. But with COVID-19, doctors are finding that some patients can linger unconscious for days, weeks or even longer. Patients coming off a ventilator typically take hours, even a day to wake up as the drugs that help them tolerate the machine wear off.
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