TY - JOUR
T1 - Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients
AU - for the GECOVID-19 Group
AU - Battaglini, Denise
AU - Santori, Gregorio
AU - Chandraptham, Karthikka
AU - Iannuzzi, Francesca
AU - Bastianello, Matilde
AU - Tarantino, Fabio
AU - Ball, Lorenzo
AU - Giacobbe, Daniele Roberto
AU - Vena, Antonio
AU - Bassetti, Matteo
AU - Inglese, Matilde
AU - Uccelli, Antonio
AU - Rocco, Patricia Rieken Macedo
AU - Patroniti, Nicolò
AU - Brunetti, Iole
AU - Pelosi, Paolo
AU - Robba, Chiara
N1 - Funding Information:
We would like the names of the individual members of the *GECOVID-19 collaborators to be searchable through their individual PubMed records. This manuscript has been released as a pre-print at https://www.researchsquare.com/article/rs-57910/v1, licensed under a Creative Commons Attribution 4.0 International License.
Publisher Copyright:
© Copyright © 2020 Battaglini, Santori, Chandraptham, Iannuzzi, Bastianello, Tarantino, Ball, Giacobbe, Vena, Bassetti, Inglese, Uccelli, Rocco, Patroniti, Brunetti, Pelosi and Robba.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11/27
Y1 - 2020/11/27
N2 - Purpose: The incidence and the clinical presentation of neurological manifestations of coronavirus disease-2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available. Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and the type of neurological complications in critically ill COVID-19 patients and their effect on survival as well as on hospital and intensive care unit (ICU) length of stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial Doppler, optic nerve sheath diameter (ONSD), and automated pupillometry. Results: Ninety-four patients with COVID-19 admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 50% of patients, with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days, p < 0.001) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days, p < 0.001) stay. The duration of mechanical ventilation was independently associated with the risk of developing neurological complications (odds ratio 1.100, 95% CI 1.046–1.175, p = 0.001). Patients with increased intracranial pressure measured by ONSD (19% of the overall population) had longer ICU stay. Conclusions: Neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length of stay. Multimodal noninvasive neuromonitoring systems are useful tools for the early detection of variations in cerebrovascular parameters in COVID-19.
AB - Purpose: The incidence and the clinical presentation of neurological manifestations of coronavirus disease-2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available. Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and the type of neurological complications in critically ill COVID-19 patients and their effect on survival as well as on hospital and intensive care unit (ICU) length of stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial Doppler, optic nerve sheath diameter (ONSD), and automated pupillometry. Results: Ninety-four patients with COVID-19 admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 50% of patients, with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days, p < 0.001) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days, p < 0.001) stay. The duration of mechanical ventilation was independently associated with the risk of developing neurological complications (odds ratio 1.100, 95% CI 1.046–1.175, p = 0.001). Patients with increased intracranial pressure measured by ONSD (19% of the overall population) had longer ICU stay. Conclusions: Neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length of stay. Multimodal noninvasive neuromonitoring systems are useful tools for the early detection of variations in cerebrovascular parameters in COVID-19.
KW - COVID-19
KW - neurocritical care
KW - neurological complications
KW - neuromonitoring
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85097554036&partnerID=8YFLogxK
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U2 - 10.3389/fneur.2020.602114
DO - 10.3389/fneur.2020.602114
M3 - Article
AN - SCOPUS:85097554036
VL - 11
JO - Frontiers in Neurology
JF - Frontiers in Neurology
SN - 1664-2295
M1 - 602114
ER -