Prolonged Unconsciousness is Common in COVID-19 and Associated with Hypoxemia.
Prolonged Unconsciousness is Common in COVID-19 and Associated with Hypoxemia.
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DOI：
10.1002/ana.26342
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发表时间：
2022-06
影响因子：
11.2
通讯作者：
Claassen, Jan
中科院分区：
文献类型：
--
作者：
Waldrop, Greer;Safavynia, Seyed A.;Barra, Megan E.;Agarwal, Sachin;Berlin, David A.;Boehme, Amelia K.;Brodie, Daniel;Choi, Jacky M.;Doyle, Kevin;Fins, Joseph J.;Ganglberger, Wolfgang;Hoffman, Katherine;Mittel, Aaron M.;Roh, David;Mukerji, Shibani S.;Nigoghossian, Caroline Der;Park, Soojin;Schenck, Edward J.;Salazar-Schicchi, John;Shen, Qi;Sholle, Evan;Velazquez, Angela G.;Walline, Maria C.;Westover, M. Brandon;Brown, Emery N.;Victor, Jonathan;Edlow, Brian L.;Schiff, Nicholas D.;Claassen, Jan
这项研究的目的是估计命令跟随的恢复时间，以及低氧血症与命令跟随恢复时间之间的关系。在这项多中心的回顾性队列研究中，在美国ʼ大流行初期(2020年3-7月)，我们使用Kaplan Meier累积发病曲线和COX比例风险模型估计了从插管到恢复命令跟随的时间。如果患者因2019年严重冠状病毒病(新冠肺炎)而进入3家医院中的1家，需要至少7 天的气管插管，并经历意识障碍(格拉斯哥昏迷量表运动评分和lt；6)，则包括在内。在795名患者中，有571名患者恢复了命令。恢复听从命令的中位时间为30 天(95%可信区间[CI]=0.27-32 天)。动脉血氧分压(PaO2值)至少有一次发作的患者在停止机械通气后10 天后，≤55 (p <； 0.001)和25%的患者恢复≥的中位时间延长了16 天。命令后恢复的时间与低氧血症有关(PaO2 ≤55 毫米汞危险比[HR]=40.56，95%CI=90.46-0.68；PaO2 ≤70 HR=60.88，95%CI=60.85-0.91)，低氧血症每增加一天，康复的可能性就会降低，这是包括镇静在内的混杂因素的原因。这些发现在没有任何结构性脑损伤想象证据的患者中得到证实(n=199)，并在非重叠的第二次激增队列中得到证实(n=427,2020年10月至2021年4月)。重症新冠肺炎的幸存者通常在停止机械通气几周后恢复意识。较长的恢复期与更严重的低氧血症相关。这种关系不能通过临床影像上发现的镇静或脑损伤来解释，而应该为维持生命的治疗提供决策依据。Ann Neurol 2022；91：740-755
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. 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). 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). 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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影响因子：
3.9
作者：
Guina J;Merrill B
通讯作者：
Merrill B
COVID-19与19号相关的急性肾脏损伤：第25次急性疾病质量倡议（ADQI）工作组的共识报告。
DOI：
10.1038/s41581-020-00356-5
发表时间：
2020-12
期刊：
Nature reviews. Nephrology
影响因子：
--
作者：
Nadim MK;Forni LG;Mehta RL;Connor MJ Jr;Liu KD;Ostermann M;Rimmelé T;Zarbock A;Bell S;Bihorac A;Cantaluppi V;Hoste E;Husain-Syed F;Germain MJ;Goldstein SL;Gupta S;Joannidis M;Kashani K;Koyner JL;Legrand M;Lumlertgul N;Mohan S;Pannu N;Peng Z;Perez-Fernandez XL;Pickkers P;Prowle J;Reis T;Srisawat N;Tolwani A;Vijayan A;Villa G;Yang L;Ronco C;Kellum JA
通讯作者：
Kellum JA
影响因子：
11.2
作者：
Forgacs, Peter B.;Devinsky, Orrin;Schiff, Nicholas D.
通讯作者：
Schiff, Nicholas D.
影响因子：
4.1
作者：
MacLaren, R;Sullivan, PW
通讯作者：
Sullivan, PW
DOI：
10.1007/bf03206565
发表时间：
2004-01-01
期刊：
NeuroRx : the journal of the American Society for Experimental NeuroTherapeutics
影响因子：
--
作者：
Sharp, Frank R;Ran, Ruiqiong;Bernaudin, Myriam
通讯作者：
Bernaudin, Myriam