Uncovering Consciousness in Unresponsive ICU Patients: Technical, Medical and Ethical Considerations

Rohaut, Benjamin; Eliseyev, Andrey; Claassen, Jan

doi:10.1007/978-3-030-06067-1_34

Cited by 9 publications

(10 citation statements)

References 48 publications

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“…Approaches that integrate task-based fMRI and EEG are currently being used to characterize the clinical characteristics of CMD in patients in the ICU and provide insights into its underlying mechanisms 169 . Meaningful communication with CMD patients is currently infeasible but, in the future, EEG-supported brain–computer interface systems could enable patients with acute CMD to communicate 175 , 176 .…”

Section: Acute Disorders Of Consciousnessmentioning

confidence: 99%

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

et al. 2020

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Section: Acute Disorders Of Consciousnessmentioning

confidence: 99%

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

et al. 2020

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“…Besides, in the literature, there is some concern about the importance of being aware that having an unresponsive sedated patient does not necessarily mean that is unaware. 14 This concern has showed that the exploration of consciousness is in its infancy 36 outside operating theater or intensive care contexts.…”

Section: Terms Definitions and Clinical Practicementioning

confidence: 99%

Clinical Aspects of Palliative Sedation in Prospective Studies. A Systematic Review

Arantzamendi

Belar

Payne

et al. 2021

Journal of Pain and Symptom Management

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Context. Near the end of life when patients experience refractory symptoms, palliative sedation may be considered as a last treatment. Clinical guidelines have been developed, but they are mainly based on expert opinion or retrospective chart reviews. Therefore, evidence for the clinical aspects of palliative sedation is needed. Objectives. To explore clinical aspects of palliative sedation in recent prospective studies. Methods. Systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered at PROSPERO. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014eDecember 2019), combining sedation, palliative care, and prospective. Article quality was assessed. Results. Ten prospective articles were included, involving predominantly patients with cancer. Most frequently reported refractory symptoms were delirium (41%e83%), pain (25%e65%), and dyspnea (16%e59%). In some articles, psychological and existential distress were mentioned (16%e59%). Only a few articles specified the tools used to assess symptoms. Level of sedation assessment tools were the Richmond Agitation Sedation Scale, Ramsay Sedation Scale, Glasgow Coma Scale, and Bispectral Index monitoring. The palliative sedation practice shows an underlying need for proportionality in relation to symptom intensity. Midazolam was the main sedative used. Other reported medications were phenobarbital, promethazine, and anesthetic medicationdpropofol. The only study that reported level of patient's discomfort as a palliative sedation outcome showed a decrease in patient discomfort. Conclusion. Assessment of refractory symptoms should include physical evaluation with standardized tools applied and interviews for psychological and existential evaluation by expert clinicians working in teams. Future research needs to evaluate the effectiveness of palliative sedation for refractory symptom relief.

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“…It is thus unsurprising that as many as 40% of non‐communicating patients with DoC may be wrongly classified as being in the vegetative state/unresponsive wakefulness syndrome (VS/UWS) . This has major ethical and practical implications for patients and their caregivers, including prognosis, treatment, resource allocation and end‐of‐life decisions .…”

Section: Introductionmentioning

confidence: 99%

European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness

Kondziella

Bender

Diserens

et al. 2020

Euro J of Neurology

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Uncovering Consciousness in Unresponsive ICU Patients: Technical, Medical and Ethical Considerations

Cited by 9 publications

References 48 publications

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

Clinical Aspects of Palliative Sedation in Prospective Studies. A Systematic Review

European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness

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