"So there are many potential contributing factors," Edlow says. Some of these patients have inflammation related to COVID-19 that may disrupt signals in the brain, and some experience blood clots that have caused strokes. Low oxygen levels, due to the virus's effect on lungs, may damage the brain. COVID-19 patients appear to need larger doses of sedatives while on a ventilator, and they're often intubated for longer periods of time than is typical for other diseases that cause pneumonia. There are lots of theories about why COVID-19 patients may take longer to regain consciousness than other ventilated patients, if they wake up at all. "It is very difficult for us to determine whether any given patient's future will bring a quality of life that would be acceptable to them," Edlow says, "based on what they've told their families or written in a prior directive."
Some families in that situation have decided to remove other life supports so the patient can die. Given all the unknowns, doctors at the hospital have had a hard time advising families when a patient has remained unresponsive for weeks, post-ventilator. Brian Edlow, a critical care neurologist at Mass General. "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 will take any individual patient to recover consciousness," says Dr. Their candid and consistent answer was: We don't know. Every day, sometimes several times a day, she would ask Frank's doctors for more information: What's going on inside his brain? Why is this happening? When might something change?
Leslie Cutitta struggled to imagine the restricted life Frank might face. Leslie Cutitta recalls a doctor asking her: "If it 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 a long-term care facility, is that something that you and he could live with?" Although he no longer needed the ventilator, he still required a feeding tube, intravenous fluids, catheters for bodily waste and some oxygen support. "It was very, very tough."ĭoctors who are studying the phenomenon of prolonged unresponsiveness are concerned that medical teams are not waiting long enough for these COVID-19 patients to wake up, especially when ICU beds are in high demand during the pandemic.Īs Frank's unresponsive condition continued, it prompted a new conversation between the medical team and his wife about whether to continue life support. "It was a long, difficult period of not - just not knowing whether he was going to come back to the Frank we knew and loved," says Leslie Cutitta. There's no official term for the problem, but it's being called a "prolonged" or "persistent" coma or unresponsiveness.įrank Cutitta, 68, was one of those patients. and in other countries have noted a troubling phenomenon associated with some COVID-19 cases: Even after extubation, some patients remain unconscious for days, weeks or longer. The body needs that time to clear the drugs that keep the patient sedated and comfortable - able to tolerate intubation and mechanical ventilation. The Coronavirus Crisis What It's Like When COVID-19 Lasts For MonthsĪfter the removal, it typically takes hours, maybe a day, for the patient to return to consciousness.
On April 21, after 27 days on a ventilator, Frank's lungs had recovered enough to remove the breathing tube. So the Cutittas hung on and a small army of ICU caregivers kept working. It wasn't a serious end-of-life discussion, but Cutitta knew her husband would want every possible life-saving measure. "Frank used to joke that he wanted to be frozen, like Ted Williams, until they could figure out what was wrong with him if he died," says Leslie Cutitta. So she used stories to try to describe Frank's zest for life. Hospital visits were banned, so Leslie Cutitta couldn't be with her husband or discuss his wishes with the medical team in person. The second call was just a few days later. The first conversation, in late March, was about whether to let Frank go or to try some experimental drugs and treatments. Leslie Cutitta said yes, twice, when clinicians from Massachusetts General Hospital in Boston called asking whether she wanted them to take - and then continue - extreme measures to keep her husband, Frank Cutitta, alive. A COVID-19 patient in the intensive care unit at United Memorial Medical Center in Houston on July 28.
0 kommentar(er)
