Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period

Objective: This study aims to evaluate data from coronavirus disease-2019 (COVID-19) patients with neurological manifestations hospitalized in the intensive care unit (ICU). Materials and Methods: The study included data from COVID-19 patients with neurological manifestations hospitalized in ICU. Patients’ demographic characteristics, risk factors, laboratory results, treatment methods, mechanical ventilation methods, use of non-invasive techniques to meet O 2 requirements, clinical outcome at discharge and after three months, and mortality rates were evaluated. Results: The study included 25 patients. Mean age of the patients was 66.76±12.93. Fifty two percent of the patients were male. Of the patients 96% had a positive polymerase chain reaction test, and 92% had lung involvement. The comorbidities of the patients were hypertension (48%), diabetes mellitus (28%), coronary artery disease (28%), cerebrovascular disease (20%), cancer (20%), and chronic obstructive pulmonary disease (12%). Seventy two percent of the patients presented with stroke. Of the patients %12 presented with encephalopathy, whereas patients with epilepsy and myasthenia gravis accounted for 8%. Patients’ average length of stay in ICU was 13.16±12.44 days. Pressure-synchronized intermittent mandatory ventilation mode was used in 56% of patients. Number of intubation days was 9.5±12.26. All patients were treated with favipiravir and antiaggregant, 92% with steroids and antibacterial therapy, 52% with antiaggregant, 20% with plasma therapy, 8% with cytokine filter and immunoglobulin therapy, and 4% with monoclonal antibody therapy. During hospitalization, mortality rate was 48%, good clinical outcome rate was 36%. Conclusion: The rates of poor clinical outcomes are seen to be high during in-hospital treatment and follow-up of COVID-19 patients presenting with neurological symptoms, as well as at discharge.

Anahtar Kelime:

COVID-19 Pandemi Sürecinde Nöroloji Yoğun Bakımda Hasta Yönetimi

Öz:

Amaç: Bu çalışmada yoğun bakım ünitesine (YBÜ) yatan nörolojik manifestasyonları olan koronavirüs hastalığı-2019 (COVID-19) hastalarının verilerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmaya nöroloji YBÜ’de nörolojik manifestasyonlar ile yatan COVID-19 hastalarının verileri dahil edildi. Hastaların demografik özellikleri, risk faktörleri, laboratuvar sonuçları, tedavi yöntemleri, mekanik ventilasyon süreçleri, O 2 ihtiyacını karşılayan non-invazif yöntemlerin kullanımı, taburculuk ve 3. ayda klinik sonlanım oranları, ölüm oranları değerlendirildi. Bulgular: Çalışmaya nörolojik prezentasyonu olan toplam 25 COVID-19 hastası dahil edildi. Hastaların yaş ortalaması 66,76±12,93 (36-83) idi. Yüzde 52 oranını erkek cinsiyet oluşturuyordu. Hastaların %96’sında polimeraz zincir reaksiyonu testi pozitif, %92 oranında akciğer tutulumu vardı. Hastaların komorbitesini %48 hipertansiyon, %28 diabetes mellitus ve koroner arter hastalığı, %20 serebrovasküler hastalık, %20 kanser, %12 kronik obstriktif akciğer hastalığı oluşturdu. Hastaların %72’si inme ile prezente olan COVID-19 grubundan oluşuyordu. Yüzde 12 ensefalopati tablosunda gelen COVID-19 hastalarından, %8 epilepsi ve miyastenia gravis semptomları ile gelen hastalardan oluşuyordu. Hastaların ortalama YBÜ yatış süresi 13,16±12,44 gündü. Hastaların %56’sı yüksek mekanik ventilatör ayarlarında, senkronize intermittent mekanik ventilasyon modunda takip edildi. Entübasyon gün sayısı 9,5±12,26 idi. Hastaların tümüne favipravir ve antiagregan, %92’sine steroid ve antibakterial tedavi, %52’sine antiagregan, %20’sine plazma tedavisi, %8’ine sitokin filtiresi ve immünoglobulin tedavisi, %4’üne monoklonal antikor tedavisi uygulandı. Hastaların yatışı sürecinde ölümle sonuçlanma oranı %48, iyi klinik sonlanım oranı %36, saptandı. Sonuç: Nörolojik belirtilerle gelen COVID-19 hastalarının hastane içi tedavi ve takip sürecinde, aynı zamanda taburculuklarında kötü klinik sonlanım oranları yüksek görülmektedir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Evren E, Us E. COVID-19 Etkeni. Memikoğlu O, Genç V (eds). COVID-19. Genişletilmiş İkinci Baskı. ISBN: 978-605-136-516-9. Ankara Üniversitesi Basımevi. E-book.
2. Acar T, Acar BA, Aras YG, et al. Demographic characteristics and neurological comorbidity of patients with COVID-19. Rev Assoc Med Bras (1992) 2020;66(Suppl 2):82-85.
3. Ak G, Bayar MK. Sitokin Fırtınası ve COVID-19. Memikoğlu O, Genç V (eds). COVID-19. Genişletilmiş İkinci Baskı. ISBN: 978-605-136-516-9. Ankara Üniversitesi Basımevi. E-book.
4. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020;46:586-590.
5. Desai I, Manchanda R, Kumar N, Tiwari A, Kumar M. Neurological manifestations of coronavirus disease 2019: exploring past to understand present. Neurol Sci 2021;42:773-785.
6. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-513.
7. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020;395:1033-1034.
8. Gunes T. Covıd-19 May increase the rısk of ischemıc stroke: a case report. Turk J Cereb Vasc Dis 2020;26:278-281.
9. Chou SH, Beghi E, Helbok R, et al. Global incidence of neurological manifestations among patients hospitalized with COVID-19-a report for the GCS-neuro COVID consortium and the energy consortium. JAMA Netw Open 2021;4:e2112131.
10. Ntaios G, Michel P, Georgiopoulos G, et al. Characteristics and outcomes in patients with COVID-19 and acute ischemic stroke: the global COVID-19 stroke registry. Stroke 2020;51:e254-e258.
11. Rothstein A, Oldridge O, Schwennesen H, Do D, Cucchiara BL. Acute cerebrovascular events in hospitalized COVID-19 patients. Stroke 2020;51:e219-e222.
12. Tavanaei R, Yazdani KO, Akhlaghpasand M, Zali A, Oraee-Yazdani S. Changed pattern of hospital admission in stroke during COVID-19 pandemic period in Iran: a retrospective study. Neurol Sci 2021;42:445- 453.
13. Wang A, Mandigo GK, Yim PD, Meyers PM, Lavine SD. Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics. J Neurointerv Surg 2020;12:648- 653.
14. Elmalı AD, Bebek N, Yıldırım İ, et al. COVID-19 and epilepsy: its effects on seizures, treatment and social life. Arch Epilepsy 2020;26:49-58.
15. Cabezudo-García P, Ciano-Petersen NL, Mena-Vázquez N, et al. Incidence and case fatality rate of COVID-19 in patients with active epilepsy. Neurology 2020;95:e1417-e1425.
16. Fu L, Wang B, Yuan T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect 2020;80:656-665.
17. Fonseca E, Quintana M, Lallana S, et al. Epilepsy in time of COVID-19: A survey-based study. Acta Neurol Scand 2020;142:545-554.
18. Sorbello M, El-Boghdadly K, Di Giacinto I, et al. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia 2020;75:724-732.
19. Lu L, Xiong W, Liu D, et al. New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: a retrospective multicenter study. Epilepsia 2020;61:e49-e53.
20. French JA, Brodie MJ, Caraballo R, et al. Keeping people with epilepsy safe during the Covid-19 pandemic. Neurology 2020;94:1032-1037.
21. Shah VA, Nalleballe K, Zaghlouleh ME, Onteddu S. Acute encephalopathy is associated with worse outcomes in COVID-19 patients. Brain Behav Immun Health 2020;8:100136.
22. Gummi RR, Kukulka NA, Deroche CB, Govindarajan R. Factors associated with acute exacerbations of myasthenia gravis. Muscle Nerve 2019;60:693- 699.
23. Camelo-Filho AE, Silva AMS, Estephan EP, et al. Myasthenia gravis and COVID-19: clinical characteristics and outcomes. Front Neurol 2020;11:1053.
24. Anand P, Slama MCC, Kaku M, et al. COVID-19 in patients with myasthenia gravis. Muscle Nerve 2020;62:254-258.
25. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-690.
26. TC. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü ‘‘COVID-19 Rehberi'' 2020. Available from: https://covid19.saglik.gov.tr/TR-66301/covid-19- rehberi.html
27. Horby P, Lim WS, Emberson JR, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384,8:693-704.
28. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis 2015;211:80-90.
29. Xu K, Cai H, Shen Y, et al. [Management of corona virus disease-19 (COVID-19): the Zhejiang experience]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020;49:147-157.
30. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-513.
31. Talan L, Altıntas D. COVID-19 ve Yoğun Bakım. Memikoğlu O, Genç V (eds). COVID-19. Genişletilmiş İkinci Baskı. ISBN: 978-605-136-516-9. Ankara Üniversitesi Basımevi. E-book.
32. De Jong A, Molinari N, Sebbane M, et al. Feasibility and effectiveness of prone position in morbidly obese patients with ARDS: a case-control clinical study. Chest 2013:143:1554-1561.
33. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013:368:2159-2168.
34. Chad T, Sampson C. Prone positioning in conscious patients on medical wards: a review of the evidence and its relevance to patients with COVID-19 infection. Clin Med (Lond) 2020;20:e97-e103.
35. Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med 2016;42:1336-1349.
36. Wang K, Zhao W, Li J, Shu W, Duan J. The experience of high-flow nasal cannula in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of Chongqing, China. Ann Intensive Care 2020;10:37.
37. Agarwal A, Basmaji J, Muttalib F, et al. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth 2020;67:1217-1248.
38. Azadbakht J, Akbari M. Predicting mortality rate in ICU admitted COVID-19 patients implementing visual semi-quantitative CT severity scoring system. J Clin Images Med Case Rep 2021;2:1493.
39. Elezkurtaj S, Greuel S, Ihlow J, et al. Causes of death and comorbidities in hospitalized patients with COVID-19. Sci Rep 2021;11:4263.
40. Ghoreishi A, Arsang-Jang S, Sabaa-Ayoun Z, et al. Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran. From the CASCADE initiative: statistical analysis plan and preliminary results. J Stroke Cerebrovasc Dis 2020;29:105321.

APA	MEMMEDOVA F, Arı Sevingil s, Altuntaş KAYA F, GER AKARSU F, Mehdiyev Z, JAFAROVA U, aykaç ö, Ozdemir A (2022). Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. , 78 - 83. 10.4274/tnd.2022.43420
Chicago	MEMMEDOVA FERGANE,Arı Sevingil semra,Altuntaş KAYA Fatma,GER AKARSU FATMA,Mehdiyev Zaur,JAFAROVA ULVIYYAT,aykaç özlem,Ozdemir Atilla Ozcan Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. (2022): 78 - 83. 10.4274/tnd.2022.43420
MLA	MEMMEDOVA FERGANE,Arı Sevingil semra,Altuntaş KAYA Fatma,GER AKARSU FATMA,Mehdiyev Zaur,JAFAROVA ULVIYYAT,aykaç özlem,Ozdemir Atilla Ozcan Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. , 2022, ss.78 - 83. 10.4274/tnd.2022.43420
AMA	MEMMEDOVA F,Arı Sevingil s,Altuntaş KAYA F,GER AKARSU F,Mehdiyev Z,JAFAROVA U,aykaç ö,Ozdemir A Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. . 2022; 78 - 83. 10.4274/tnd.2022.43420
Vancouver	MEMMEDOVA F,Arı Sevingil s,Altuntaş KAYA F,GER AKARSU F,Mehdiyev Z,JAFAROVA U,aykaç ö,Ozdemir A Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. . 2022; 78 - 83. 10.4274/tnd.2022.43420
IEEE	MEMMEDOVA F,Arı Sevingil s,Altuntaş KAYA F,GER AKARSU F,Mehdiyev Z,JAFAROVA U,aykaç ö,Ozdemir A "Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period." , ss.78 - 83, 2022. 10.4274/tnd.2022.43420
ISNAD	MEMMEDOVA, FERGANE vd. "Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period". (2022), 78-83. https://doi.org/10.4274/tnd.2022.43420

APA	MEMMEDOVA F, Arı Sevingil s, Altuntaş KAYA F, GER AKARSU F, Mehdiyev Z, JAFAROVA U, aykaç ö, Ozdemir A (2022). Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. Türk Nöroloji Dergisi, 28(2), 78 - 83. 10.4274/tnd.2022.43420
Chicago	MEMMEDOVA FERGANE,Arı Sevingil semra,Altuntaş KAYA Fatma,GER AKARSU FATMA,Mehdiyev Zaur,JAFAROVA ULVIYYAT,aykaç özlem,Ozdemir Atilla Ozcan Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. Türk Nöroloji Dergisi 28, no.2 (2022): 78 - 83. 10.4274/tnd.2022.43420
MLA	MEMMEDOVA FERGANE,Arı Sevingil semra,Altuntaş KAYA Fatma,GER AKARSU FATMA,Mehdiyev Zaur,JAFAROVA ULVIYYAT,aykaç özlem,Ozdemir Atilla Ozcan Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. Türk Nöroloji Dergisi, vol.28, no.2, 2022, ss.78 - 83. 10.4274/tnd.2022.43420
AMA	MEMMEDOVA F,Arı Sevingil s,Altuntaş KAYA F,GER AKARSU F,Mehdiyev Z,JAFAROVA U,aykaç ö,Ozdemir A Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. Türk Nöroloji Dergisi. 2022; 28(2): 78 - 83. 10.4274/tnd.2022.43420
Vancouver	MEMMEDOVA F,Arı Sevingil s,Altuntaş KAYA F,GER AKARSU F,Mehdiyev Z,JAFAROVA U,aykaç ö,Ozdemir A Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period. Türk Nöroloji Dergisi. 2022; 28(2): 78 - 83. 10.4274/tnd.2022.43420
IEEE	MEMMEDOVA F,Arı Sevingil s,Altuntaş KAYA F,GER AKARSU F,Mehdiyev Z,JAFAROVA U,aykaç ö,Ozdemir A "Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period." Türk Nöroloji Dergisi, 28, ss.78 - 83, 2022. 10.4274/tnd.2022.43420
ISNAD	MEMMEDOVA, FERGANE vd. "Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period". Türk Nöroloji Dergisi 28/2 (2022), 78-83. https://doi.org/10.4274/tnd.2022.43420