Market data provided by Factset. In other scientific news on the virus: brain damage found in autopsies, the origin of the outbreak may be earlier than previously thought and the use of repeated tests is questioned. The first feature was opening of the eyes after acoustic or tactile stimuli within 1 to 12 days after sedatives were stopped. ", Learn more about the Department of Neurology, Learn more about research in the Department of Neurology, Director, Neuroscience Statistics Research Lab, Massachusetts General Hospital, Anesthesiologist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Neurologist, Massachusetts General Hospital, Primary Investigator, Delirium Lab, Massachusetts General Hospital, Assistant Professor of Neurology, Associate Director of the Neuro-infectious Diseases Unit. Some Covid-19 Patients Experience Prolonged Comas After Being Taken Off Ventilators Conscious sedation lets you recover quickly and return to your everyday activities soon after your procedure. The brain imaging abnormalities found in our described case and other patients within our series are in line with recently reported series of brain imaging in patients with COVID-19 and a postmortem neuropathologic analysis, showing microbleeds and white matter abnormalities in varying degrees.2,3 Some of these abnormalities have also been reported previously in other critical illnesses, including a prolonged reversible comatose state in a case of sepsis.4,,6 The main differential diagnosis in our case was a persistent comatose state due to parainfectious autoimmune-mediated encephalitis or critical illnessrelated encephalopathy. 66 0 obj <> endobj A ventilator may be needed when certain illnesses like COVID-19 progress to a condition known as acute respiratory distress syndrome (ARDS). Do leave the healthcare facility accompanied by a responsible adult. "All of that has been erased by Covid," said Dr. E. Wesley Ely, co-director of the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University and the Nashville Veteran's. Critically ill COVID patient survives after weeks on ventilator | 9news.com Coronavirus After weeks on a ventilator, this COVID patient's family worried he would die. Some of these patients, we wean them down off sedation, take the breathing tube out and right away they give us a thumbs up, or a few words, Nicholas Schiff, a neurologist at Weill Cornell Medicine in New York who specializes in treating disorders of consciousness, told the Washington Post. Some Covid-19 Patients Experience Prolonged Comas After Being Taken Off Ventilators, CIDRAP: Schiff said while its certainly known that prolonged sedation can extend the time it takes for patients to wake up, 12 days after sedation ends is not typical.. Search for condition information or for a specific treatment program. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Effects of Sedation on Brain Function in COVID-19 Patients Although treatment for those with COVID-19 has improved, concerns about neurological complications continue to proliferate. Meet Hemp-Derived Delta-9 THC. Frank Cutitta, 68, was one of those patients. At least some of the abnormalities appear to be linked with recent sedation," says Dr. Kimchi. But as COVID-19 patients fill ICUs across the country, it's not clear how long hospital staff will wait for those patients who do not wake up after a ventilator tube is removed. After five days on a ventilator because of covid-19, Susham Rita Singh seemed to have turned a corner. Submissions should not have more than 5 authors. Covid-19, the disease caused by the novel coronavirus, presents another complication for people on ventilators. Your email address, e.g. For NPR News, I'm Martha Bebinger in Boston. Submit. Experts Question Use Of Repeated Covid-19 Tests After A Patient Recovers Leslie and Frank Cutitta have a final request: Wear a mask. You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid Learn about career opportunities, search for positions and apply for a job. The persistent, coma-like state can last for weeks. Prolonged or persistent comas are just one area of research, but one getting a lot of attention. Copyright 2007-2023. hbbd```b``"H4 fHVwfIarVYf@q! Neurologists are frequently consulted due to neurologic symptomatology in patients with COVID-19. It also became clear that some patients required increased sedation to improve ventilation. You've successfully subscribed to this newsletter! Unless a patient has previously specified that she does not want aggressive treatment, we need to really go slow, said Giacino, because we are not at a point where we have prognostic indicators that approach the level of certainty that is necessary before making a decision that we should stop treatment because there is no chance of meaningful recovery.. Some COVID patients who do eventually regain consciousness still have cognitive difficulties. Nearly 80% of patients who stay in the ICU for a prolonged periodoften heavily sedated and ventilatedexperience cognitive problems a year or more later, according to a new study in NEJM. He didnt have a lot of them at that point, but it was just amazing, absolutely amazing.. It isn't clear how long these effects might last. August 27, 2020. endstream endobj startxref Read any comments already posted on the article prior to submission. The young mother, who gave birth at Montreals Sainte-Justine Hospital, tested positive for Covid-19 when her baby was born. "The body mounts an enormous inflammatory response, and it turns out to be pathologic as inflammation starts to damage tissues across all organ systems. A coma is a state of unconsciousness where a person is unresponsive and cannot be woken. Have questions? If you are uploading a letter concerning an article: Frank Cutitta credits the Mass General doctors and nurses, saying they became his advocates. Dr. Mukerji and her collaborators found brain injury in several regions critical for cognitive function. Additionally, adequate pain control is a . Anesthesia-induced delirium has been highly prominent in medical literature over the past decade and is associated with ventilation. Go to Neurology.org/N for full disclosures. lorazepam or diazepam for sedation and anxiety. The ripple effects of COVID-19 have reached virtually all aspects of society. (iStock), CORONAVIRUS AND HIGH ALTITUDES: HOW DISTANCE FROM SEA LEVEL OFFERS INHABITANTS LEVERAGE, One report examining the neurological implications of COVID-19 infections says the sheer volume of those suffering critical illness is likely to result in an increased burden of long-term cognitive impairment.. Satellite Data Suggests Coronavirus May Have Hit China Earlier: Researchers Low. Although treatment for those with COVID-19 has improved, concerns about neurological complications continue to proliferate. Critical and emergency care and other roles. Severe cases of the disease cause acute respiratory distress syndrome, or ARDS. We recorded demographic data, sedative dosages, prone positioning, sedation levels and duration. Mutual Fund and ETF data provided by Refinitiv Lipper. Out of four parturients with severe COVID-19 pneumonia, three patients did not survive in postoperative period due to refractory hypoxemia. Diffuse leukoencephalopathy with restricted diffusion in the corona radiata and subcortical white matter on the first MRI slightly decreased on follow-up MRIs. "It would get to 193 beats per minute," she says. From WBUR in Boston, Martha Bebinger has this story. For more information about these cookies and the data The expectation is that you should start waking up after six hours, 12 hours or a day, said her daughter, Silky Singh Pahlajani, a neurologist in New York City. Around midnight on April 8, doctors at Houston Methodist Hospital turned off the sedative drip that had kept the previously healthy 65-year-old in a medically induced coma. Do not be redundant. When things were calming down in the Northeast, there were reports of patients who were not waking up, says Dr. Brown. He just didnt wake up. Low tidal volume ventilation Many people are familiar with propofol, which produces sleep or hypnosis and is used by . Safe Care CommitmentGet the latest news on COVID-19, the vaccine and care at Mass General.Learn more. COVID-19, Neurointerventional Imaging, Neurology, Neuroscience, Radiology, Research and Innovation. But there are others who are still not following commands and still not expressing themselves weeks later., WHO BELIEVES PROTESTS IMPORTANT AMID CORONAVIRUS PANDEMIC. All rights reserved. She started to move her fingers for the first time on ICU day 63. The sedative midazolam was stopped on ICU day 10, and the sedative propofol was stopped on ICU day 14. At least we knew he was in there somewhere, she said. It could have gone the other way, he said, if clinicians had decided Look, this guys just way too sick, and weve got other patients who need this equipment. Or we have an advocate who says, Throw the kitchen sink at him,' Frank said. Heitz says anesthesia remains a mystery on many levels, for example, it is not yet understood how exactly the process works, and there is no serious research on what aspect of going under makes some people cry when they wake up. Physicians and researchers at Mass General will continue to work on disentangling the effects of sedation on the neurological impacts of COVID-19and to improve patient treatment. She developed an acute kidney injury necessitating dialysis from day 3 until ICU day 28. In this case series, prolonged level of unconsciousness with full recovery of the unconsciousness in patients with severe COVID-19 is shown. Shibani Mukerji, MD, PhDis the associate director of theNeuro-Infectious Diseases Unitat Mass General and co-author of a recently published article on neuropathological findings from the autopsies of COVID-19 patients in theNew England Journal of Medicine. Haroon Siddique. Her fever hit 105 degrees. From the Departments of Intensive Care (W.F.A., J.G.v.d.H. He's home now, doing physical therapy. and apply to letter. Lines and paragraphs break automatically. For some people, post-COVID conditions can last weeks, months, or years after COVID-19 illness and can sometimes result in disability. The General Hospital Corporation. Salter says some patients in the ICU stay for about two weeks. Why this happens is unclear. Patients with COVID-19 who require intubation and ventilation have witnessed a number of stressful events in the ICU, such as emergency resuscitation procedures and deaths. Every day, sometimes several times a day, she would ask Franks doctors for more information: Whats going on inside his brain? As with finding patients being unable to fully awake and having significant cognitive dysfunction, COVID-19 is expected to bring about the unexpected. Upon waking up six days after being put on a ventilator due to the novel coronavirus, David Lat says his first conversation with his husband was about the books he'd asked for.He said he was . To find COVID-19 vaccine locations near you: Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233. "That's what we're doing now. Let us help you navigate your in-person or virtual visit to Mass General. Market data provided by Factset. Frank Cutitta said he believes the flow of these inspiring sounds helped maintain his cognitive function. Because her consciousness level did not improve beyond opening of her eyes, the concentrations of midazolam and its metabolites were measured and were undetectable in blood on ICU day 18. To mitigate exposure to Covid-19, Dr. Mutual Fund and ETF data provided by Refinitiv Lipper. Patients are opting not to seek medical care due to fears of COVID-19. hb```f`` B@ 0S F L`>bxFv3X^gYe:g3g|-cF$F_),L@4+SlnST%@ 4 Schiff said all of his colleagues in the fieldare seeing patients with prolonged recovery, though the incidence of the cases is still unknown. Leslie Cutitta recalled a doctor asking her: If it looks like Franks not going to return mentally, and hes 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?. About 40% of elderly patients and up to one-third of children have lingering confusion and thinking problems for several days after surgery and anesthesia. Copyright 2007-2023. Some families in that situation have decided to remove other life supports so the patient can die. Hospital visits were banned, so Leslie couldnt be with her husband or discuss his wishes with the medical team in person. Inflammation of the lungs, heart and blood vessel directly follows.". Go to Neurology.org/N for full disclosures. We are committed to providing expert caresafely and effectively. Methods A case series of patients who were admitted to the intensive care unit due to COVID-19related acute respiratory failure is described. Next, 5 to 12 days later, all patients started to follow objects spontaneously with their eyes, which was still not accompanied by obeying commands. "We didn't find the virus in neurons using immunohistochemistry. Accuracy and availability may vary. Low oxygen levels, due to the viruss effect on the lungs, may damage the brain. "Prolonged anesthesia was clearly needed from a therapeutic standpoint to help the pulmonary status of COVID-19 patients," says Emery Brown, MD, PhD, anesthesiologist in theDepartment of Anesthesia, Critical Care and Pain Medicineand director of the Neuroscience Statistics Research Lab at Mass General. Covid-19 has made doctors much more likely to leave patients on sedation too long to avoid the hypothetical risk that patients might pull out their breathing tubes and the shortages of. In many cases, sedation was prolonged and sometimes for several weeks; this was much longer than for common treatments requiring sedation, such as surgery. For the study, Vanderbilt University researchers studied 821 patients with respiratory failure or septic shock who stayed in an ICU for a median of five days. (Branswell, 6/8), Hospital Investigated for Allegedly Denying an Emergency Abortion After Patient's Water Broke, Medicare Fines for High Hospital Readmissions Drop, but Nearly 2,300 Facilities Are Still Penalized, This Open Enrollment Season, Look Out for Health Insurance That Seems Too Good to Be True, What Looks Like Pot, Acts Like Pot, but Is Legal Nearly Everywhere? We offer diagnostic and treatment options for common and complex medical conditions. You must have updated your disclosures within six months: http://submit.neurology.org. A recent study in theNew England Journal of Medicineby Shibani Mukerji, MD, PhD, associate director of theNeuro-Infectious Diseases Unitat Mass General, shows that post-mortem brains of ventilated COVID-19 patients have hypoxic injury. Obeying commands (mostly through facial musculature) occurred between 8 and 31 days after cessation of sedatives. KHN is an editorially independent program of KFF (Kaiser Family Foundation). %PDF-1.6 % This material may not be published, broadcast, rewritten, NPR transcripts are created on a rush deadline by an NPR contractor. Click the button below to go to KFFs donation page which will provide more information and FAQs. Dr. Mukerji does find that those with COVID-19 had hypoxic injurymeaning that brain cells in these patients died due to lack of oxygen. Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment. She was admitted to the hospital for oxygen therapy. (See "COVID-19: Epidemiology, clinical features, and prognosis of the critically ill adult", section on 'Length of stay' .) Boston, A long ICU course in severe COVID-19 is not unusual. For some very serious surgeries, such as open-heart surgery or brain surgery, the patient is allowed to slowly wake from anesthesia with no reversal agent to bring the muscles out of paralysis. higgs-boson@gmail.com. In eight patients, spinal anesthesia was repeated due to . 02114 Hospitals are reporting that survivors are struggling from cognitive impairments and a . 6.25 mg - 12.5 mg SC/IV can be used to begin with especially if nausea is a feature. After that, doctors often begin conversations with the family about ending life support. 2023 Kaiser Family Foundation. Error: Please enter a valid email address. Over the next eight weeks, the only time she saw her baby was when the NICU staff sent photos, or when a nurse FaceTimed her while the baby was being bathed. It was very, very tough., From Dialysis not working to Spoke for first time, Frank Cutittas family kept a calendar marking his progress in the hospital from March until his return home on July 3. 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. Many hospitals use 72 hours, or three days, as the period for patients with a traumatic brain injury to regain consciousness before advising an end to life support. "Some fat-soluble sedatives, such as propofol, may prolong anesthetization and contribute to patients not waking up," says Dr. Brown. Why is this happening? But how many of those actually took a long time to wake up, we dont have numbers on that yet.. Additional anonymized data not available within the article or supplementary material are available to qualified researchers on reasonable request. 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. We distribute our journalism for free and without advertising through media partners of all sizes and in communities large and small. Tables 1 and 2 and supplementary table e-1 (available on Dryad, doi.org/10.5061/dryad.866t1g1pb) show the characteristics of 6 patients. Due to the use of sedatives and muscle relaxants during longer periods in patients with COVID-19 admitted to the ICU, such patients often develop a severe form of ICU-acquired weakness. The very premature infant was born via cesarean section and quickly whisked away to the neonatal intensive care unit before his mother could even lay eyes on him. BEBINGER: 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. Theres no official term for the problem, but its being called a prolonged or persistent coma or unresponsiveness. Brown and his colleagues are working to develop drugs to help patients more quickly emerge and recover from general anesthesia. "No, honey . 'Royal Free Hospital'. "That's still up for debate and that's still a consideration.". %%EOF This was followed by visual tracking of people within 2 weeks after cessation of sedatives. This means the patient may remain on the ventilator until they're fully conscious, which can be between six and eight hours after surgery. He began to. It was learned that an often-helpful option was to keep critically ill patients sedated for prolonged periods of time until they were able to breathe on their own. BEBINGER: And prompted more questions about whether to continue life support. 117 0 obj <>stream "We didn't see a large number of clots to speak to the amount of hypoxic injury," says Dr. Mukerji. The Cutittas said they feel incredibly lucky. As our case series shows, it is conceivable that neurologists could be faced with the dilemma to prognosticate on the basis of a prolonged state of unconsciousness, all with the background of a pandemic with the need for ICU capacity exceeding available resources. ), Neurology (A.A.A.C.M.W. 93 0 obj <>/Filter/FlateDecode/ID[<0033803CED91E4489BCBEDA906532D19><08FAFFAEE7118C48BD370A0976047613>]/Index[66 52]/Info 65 0 R/Length 124/Prev 168025/Root 67 0 R/Size 118/Type/XRef/W[1 3 1]>>stream Given all the unknowns, doctors at the hospital have had a hard time advising families of a patient who has remained unresponsive for weeks, post-ventilator. His mother, Peggy Torda-Saballa said her son was healthy before he was. Inthis autopsy series, there was no evidence of the virus that causes COVID-19 in the brain tissue of ventilated COVID-19 patients. People have been seriously harmed and even died after taking products not approved for use to treat or prevent COVID-19, even products approved or prescribed for other uses. Deutsch . Dr. Brown is hopeful. 4: The person moves away from pain. It's not a mistake but one funny part of my job is seeing patients when they wake up from anesthesia. Sedation, often used for minimally invasive surgery, blocks pain and causes sleepiness, but doesn't put you to sleep. She tested positive on the oropharyngeal swab test for severe acute respiratory syndrome coronavirus 2. All Rights Reserved. And he didn't have a lot of them at that point, but it was just amazing - absolutely amazing. This is a multicenter case series of patients with severe respiratory failure due to COVID-19 with prolonged unconsciousness after cessation of sedatives. And we happened to have the latter.. ), and Radiology (F.J.A.M. There are reports of patients who were not clearly waking up even after their respiratory system improved and sedation discontinued.". Copyright 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. 1. All mechanically ventilated adults with COVID-19-induced ARDS requiring continuously infused sedative therapy admitted between April 4, 2020, and June 30, 2020 were included. BEBINGER: Or what their mental state might be if or when they do. The COVID-19 pandemic has helped reveal the complex interaction between inflammation, sedation and neurological disorders. Dr. Sherry Chou, a neurologist at the University of Pittsburgh Medical Center, is leading the international effort. The clinical pattern from unconsciousness to awakening occurred in a similar sequence in all patients. This spring, as Edlow observed dozens of Mass General COVID-19 patients linger in this unresponsive state, he joined Claassen and other colleagues from Weill Cornell Medical College to form a research consortium. The researchers are sharing their data to determine the cause of prolonged coma in COVID-19 patients, find treatments and better predict which patients might eventually recover, given enough time and treatment. An alternative approach is a sedation algorithm designed to reduce sedation to the level needed to keep the patient in an alert, calm and cooperative state (e.g., Sedation Agitation Score = 4 . The COVID-19 Treatment Guidelines Panel (the Panel) is committed to updating this document to ensure that health care providers, patients, and policy experts have the most recent . Levomepromazine = FIRST LINE in dying patients. But then Frank did not wake up. 2023 FOX News Network, LLC. Frank did not die. And in some patients, COVID triggers blood clots that cause strokes. Patients were sedated between 14 and 31 days and showed prolonged unconsciousness after the sedatives were stopped. Subsequently, 1 to 17 days later, patients started to obey commands for the first time, which always began with facial musculature such as closing and opening of the eyes or mouth. It's lowered to around 89F to 93F (32C to 34C). All patients had a flaccid paralysis after awakening that remained present for the recorded days in the ICU or resolved only very slowly. FRANK CUTITTA: We did have an advocate in the system BEBINGER: Here's Frank last month, back at home with Leslie. Chou said families want to know whether a patient can wake up and be themselves. Answering that question depends on how accurate we are at predicting the future, and we know were not very accurate right now., A CT scan of Frank Cutittas brain showed residue from blood clots but was otherwise clean.. Diagnostic neurologic workup did not show signs of devastating brain injury. Click the button below to go to KFFs donation page which will provide more information and FAQs. Because the virus has the potential to cause extensive damage to the lungs, some patients may be unable to breathe on their own, and require intubation and subsequent ventilation in order to bring oxygen into the body. A study yesterday in The Lancet presents the clinical findings of autopsies conducted on six German patients (four men and two women, aged 58 to 82 years) who died from COVID-19 in April. As COVID-19 patients fill ICUs across the country, it's not clear how long hospital staff will wait beyond that point for those patients who do not wake up after a ventilator tube is removed. Raphael Bernard-Valnet, Sylvain Perriot, Mathieu Canales et al.Neurology: Neuroimmunology & Neuroinflammation, June 16, 2021, Guilhem Sol, Stphane Mathis, Diane Friedman et al.Neurology, February 10, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011355, Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients, COVID-19-associated diffuse leukoencephalopathy and microhemorrhages, Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology, Concomitant delayed posthypoxic leukoencephalopathy and critical illness microbleeds, Deep coma and diffuse white matter abnormalities caused by sepsis-associated encephalopathy, Intact brain network function in an unresponsive patient with COVID-19, Author Response: Prolonged Unconsciousness Following Severe COVID-19, Reader response: Prolonged Unconsciousness Following Severe COVID-19, Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy, Neurology Unit, University of Udine Medical School, Udine, Italy, Senior Professor and Researcher in Neurology, Institute of Neurology and Neurosurgery, Department of Clinical Neurophysiology, Havana, Cuba, Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS), Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), Encephalopathies Associated With Severe COVID-19 Present Neurovascular Unit Alterations Without Evidence for Strong Neuroinflammation, Impact of Coronavirus Disease 2019 in a French Cohort of Myasthenia Gravis, COVID-19 in Patients With Neuromyelitis Optica Spectrum Disorders and Myelin Oligodendrocyte Glycoprotein Antibody Disease in North America, A New England COVID-19 Registry of Patients With CNS Demyelinating Disease, Neurology: Neuroimmunology & Neuroinflammation. Many veterinary procedures require your pet to be put under anesthesia so that it will not feel pain and will remain still. It was very tough, very tough. "We now have a bit of perspective, and we can start to put the stories together, think about pathophysiologic mechanisms and help define the symptoms that we saw," he says. A case reported by Edlow in July described a patient who moved between a coma and minimal consciousness for several weeks and was eventually able to follow commands. We appreciate all forms of engagement from our readers and listeners, and welcome your support. Learn about the many ways you can get involved and support Mass General. The treatment usually lasts about 24 hours. Do remain quietly at home for the day and rest. Because long-term sedation for COVID-19 patients could last several weeks, prolonged sedation increases the chance of hypoxia and causes neurological trauma. All authors report no conflicts of interest or relevant financial relationships related to this manuscript. Explore fellowships, residencies, internships and other educational opportunities. If you are responding to a comment that was written about an article you originally authored: L CUTITTA: You know, smile, Daddy. Some medical ethicists also urge clinicians not to rush when it comes to decisions about how quickly COVID-19 patients may return to consciousness. The Article Processing Charge was funded by the authors. Mass General is pleased to provide the public with information on health, wellness and research topics related to COVID-19. "You're more likely to have hypoxic-ischemic injury in prolonged ventilation patients. Doctors are studying a troubling development in some COVID-19 patients: They survive the ventilator, but don't wake up. ), Prolonged Unconsciousness Following Severe COVID-19. The COVID-19 pandemic has helped reveal the complex interaction between inflammation, sedation and cognitive dysfunction Long-term sedation for COVID-19 patients could last several weeks, increases the chance of cognitive dysfunction and is linked to hypoxic injury Dr. Brown relates, I think that where we're going to see residual effects, over the next several years we will see patients with a broad range of symptoms.. The effectiveness of sedation has traditionally been evaluated in terms of patient and surgeon satisfaction, but the most important goal is not to induce a deep sleep in the patient, but rather to ensure that the surgery is performed safely and as planned. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. If a story is labeled All Rights Reserved, we cannot grant permission to republish that item. In our experience, approximately every fifth patient that was hospitalized was admitted to the ICU and had some degree of disorders of consciousness, said Dr. Jan Claassen, director of neurocritical care at New Yorks Columbia University Medical Center.
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