Another COVID-19 Medical Mystery: Patients Come Off Ventilator But Linger In A Coma

Another COVID-19 Medical Mystery: Patients Come Off Ventilator But Linger In A Coma Doctors are researching why some patients remain unconscious for days or weeks, even after sedating drugs are withdrawn. They also worry that these patients aren't being given time to recover. NPR.org

 ... doctors across the U.S. 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. There's no official term for the problem, but it's being called a "prolonged" or "persistent" coma or unresponsiveness.

Frank Cutitta, 68, was one of those patients. He just didn't wake up.

"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. "It was very, very tough."

Doctors 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.

As Frank's unresponsive condition continued, it prompted a new conversation between the medical team and his wife about whether to continue life support. Although he no longer needed the ventilator, he still required a feeding tube, intravenous fluids, catheters for bodily waste and some oxygen support.

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?"

Leslie Cutitta struggled to imagine the restricted life Frank might face. 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?

Their candid and consistent answer was: We don't know.

"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. Brian Edlow, a critical care neurologist at Mass General.

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. Some families in that situation have decided to remove other life supports so the patient can die. Edlow can't say how many. ...