Persistent vegetative state: an overview

Abstract

Background Disorder of consciousness diagnosis, especially when is classified as persistent vegetative state (without misestimating the other diagnosis classifications), in the intensive care is an important diagnosis to evaluate and treat. Persistent vegetative state diagnosis is a challenge in the daily clinical practice because the diagnosis is made mainly based upon the clinical history and the patient behavior observation. There are some specific criteria for this diagnosis, and this could be very tricky when the physician is not well trained. Main body We made a literature review regarding the persistent vegetative state diagnosis, clinical features, management, prognosis, and daily medical practice challenges while considering the bioethical issues and the family perspective about the patient status. The objective of this overview is to provide updated information regarding this clinical state’s features while considering the current medical literature available. Conclusions Regardless of the currently available guidelines and literature, there is still a lot of what we do not know about the persistent vegetative state. There is a lack of evidence regarding the optimal diagnosis and even more, about how to expect a natural history of this disorder of consciousness. It is important to recall that the patients (despite of their altered mental state diagnosis) should always be treated to avoid some of the intensive care unit long-stance complications.

Regulating liminality: Making sense of the vegetative state and defining the limits of end‐of‐life action

“…Being wakeful, they retain basic life functions, such as regular sleep-wake cycles, spontaneous movements and autonomous breath, but nevertheless depend on ANH (RCP, 2020). Six months after the diagnosis, medicine considers the vegetative state as 'permanent', with patients having low chances of regaining awareness (Quiñones-Ossa et al, 2021). Moreover, in the (so far) few cases of misdiagnosis and late recovery, patients remained with a severe permanent disability (Wade, 2018).…”