Abstract
Chronic disorders of consciousness (DOC) develop after severe traumatic and non-traumatic brain damage and are characterized by the restoration of wakefulness in a patient after a coma without the recovery of consciousness. To optimize the diagnosis and treatment of patients with chronic DOC, a Russian working group on the problems of chronic DOC was organized, which included specialists in various areas, primarily anesthesiologists, critical care physicians and neurologists. While discussing the terminology of chronic DOC, the group identified that currently there is no definition for the state that falls into the period from the recovery of wakefulness and until 28 days after the brain damage when vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS) may be diagnosed. In the intensive care unit (ICU) setting, there is often no consultant to provide critical care physicians with the correct diagnosis of the latter clinical syndromes, and neurophysiological tests are not feasible either. Therefore, there is a need to create a set of simple, understandable and easily reproducible strategies for managing this category of patients in the ICU. Thus, the working group proposed the term “prolonged disorders of consciousness” to be used for the patients with the signs of VS/UWS or MCS syndromes during their stay in the ICU until 28 days after initial brain damage and/or until the correct differential diagnosis of a type of chronic DOC is made. With the introduction of prolonged disorders of consciousness definition, the regular ICU staff will better understand how to provide an optimal set of supportive therapy and early rehabilitation activities in the lack of specific diagnostics techniques and dedicated specialists. Allocation of this category of patients allows us to create an algorithm for their better diagnosis and management and ensures consistent and effective interdisciplinary care at various levels. On the one hand, this approach will help us allow to free up ICU beds that are in high demand, while on the other, it will maximize the opportunity to realize the rehabilitation potential of DOC patients due to timely transfer to specialized centers.
Conclusion. If the term “prolonged disorder of consciousness” is accepted by professional communities of specialists (critical care physicians, neurologists, neurosurgeons, etc.), it will be used in guidelines for the management of DOC patients.
References
- Пирадов М.А., Супонева Н.А., Вознюк И.А. и др. Хронические нарушения сознания: терминология и диагностические критерии. Результаты первого заседания Российской рабочей группы по проблемам хронических нарушений сознания. Анналы клинической и экспериментальной неврологии. 2020; 14(1): 5–16. DOI: 10.25692/ACEN.2020.1.1. [Piradov M.A., Suponeva N.A., Voznyuk I.A., et al. Chronic disorders of consciousness: terminology and diagnostic criteria. The results of the first meeting of the Russian Working Group for Chronic Disorders of Consciousness. Annals of Clinical and Experimental Neurology. 2020; 14(1): 5–16. (In Russ)]
- Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med. 1994; 330(21): 1499–508. DOI: 10.1056/NEJM199405263302107.
- College of Physicians, R. (2020). Prolonged disorders of consciousness following sudden onset brain injury: National clinical guidelines. Retrieved from www.rcplondon.ac.uk.
- Teasdale G., Jennett, B. Assessment of coma and impaired consciousness. A practical scale. Lancet (London, England). 1974; 2: 81–4. DOI: 10.1016/s0140-6736(74)91639-0.
- Teasdale G., Maas A., Lecky F., et al. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet. Neurol. 2014; 13: 844–54. DOI: 10.1016/S1474-4422(14)70120-6.
- Wijdicks E.F.M., Bamlet W.R., Maramattom B.V, et al. Validation of a new coma scale: The FOUR score. Ann. Neurol. 2005; 58: 585–93. DOI: 10.1002/ana.20611.
- Пирадов М.А., Супонева Н.А., Рябинкина Ю.В. и др. Шкала подробной оценки состояния ареактивных пациентов (Full Outline of UnResponsiveness, FOUR): перевод и лингвокультурная адаптация русскоязычной версии. Анналы клинической и экспериментальной неврологии. 2019; 13: 47–54. DOI: 10.25692/ACEN.2019.3.7. [Piradov M.A., Suponeva N.A., Ryabinkina Yu.V., et al. Full Outline of UnResponsiveness (FOUR) scale: translation and linguistic and cultural adaptation of the Russian language version. Annals of Clinical and Experimental Neurology. 2019; 13: 47–54. (In Russ)]
- Белкин А.А., Заболотских И.Б., Бочкарев П.Ю. и др. Первый опыт применения шкалы «подробной оценки состояния ареактивных пациентов» (FOUR SCALE) у пациентов с острой церебральной недостаточностью. Двухцентровое исследование «FOUR-Rus». Вестник интенсивной терапии им. А.И. Салтанова. 2020; 3: 29–36. DOI: 10.21320/1818–474X-2020-3-27-34. [Belkin A.A., Zabolotskikh I.B., Bochkarev P.Yu., et al. The first experience of application of “full outline of unresponsiveness” (FOUR SCALE) in patients with acute cerebral insufficiency. Two-center research “FOUR-Rus”. Two-center trial. Annals of Critical Care. 2020; 3: 27–34. (In Russ)]
- Posner J.B., Saper C.B., Schiff N.D., et al. Plum and Posner’s Diagnosis and Treatment of Stupor and Coma. Oxford University Press, 2019.
- Крылов В.В., Кондратьев А.Н., Лубнин А.Ю. и др. Рекомендации по диагностике и реверсии остаточного нейромышечного блока в нейрохирургии. Вестник интенсивной терапии. 2011; 4: 52–62. [Krylov V.V., Kondrat`ev A.N., Lubnin A.Yu., et al. Rekomendacii po diagnostike i reversii ostatochnogo nejromy`shechnogo bloka v nejroxirurgii. Vestnik intensivnoj terapii. 2011; 4: 52–62. (In Russ)]
- Schnakers C., Zasler N. Assessment and Management of Pain in Patients With Disorders of Consciousness. PM&R. 2015; 7: 270–7. DOI: 10.1016/j.pmrj.2015.09.016.
- Boly M., Faymonville M.E., Schnakers C., et al. Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurol. 2008; 7: 1013–20 DOI: 10.1016/S1474-4422(08)70219-9.
- Chatelle C., Thibaut A., Whyte J., et al. Pain issues in disorders of consciousness. Brain Inj. 2014; 28: 1202–8. DOI: 10.3109/02699052.2014.920518.
- Haddad S.H., Arabi Y.M. Critical care management of severe traumatic brain injury in adults. Scand. J. Trauma. Resusc. Emerg. Med. 2012; 20: 12. DOI: 10.1186/1757-7241-20-12.
- Белкин А.А., Давыдова Н.С., Лейдерман И.Н. и др. Реабилитация в интенсивной терапии. В кн.: Клинические рекомендации. Анестезиология и реаниматология. М.: ГЭОТАР-медиа, 2016. С. 833–58. [Belkin A.A., Davy`dova N.S., Leiderman I.N., et al. Reabilitaciya v intensivnoj terapii. In: Klinicheskie rekomendacii. Anesteziologiya i reanimatologia. Moscow: GEOTAR-media, 2016, S. 833–58. (In Russ)]
- Seel R.T., Douglas J., Dennison A.C., et al. Specialized early treatment for persons with disorders of consciousness: Program components and outcomes. Arch. Phys. Med. Rehabil. 2013; 94: 1908–23. DOI: 10.1016/j.apmr.2012.11.052.
- Klingshirn H., Grill E., Bender A., et al. Quality of evidence of rehabilitation interventions in longterm care for people with severe disorders of consciousness after brain injury: A systematic review. J. Rehabil. Med. 2015; 47: 577–85. DOI: 10.2340/16501977-1983.
- Seel R.T., Douglas J., Dennison A.C., et al. Specialized early treatment for persons with disorders of consciousness: Program components and outcomes. Arch. Phys. Med. Rehabil. 2013; 94: 1908–23. DOI: 10.1016/j.apmr.2012.11.052.
- Mélotte E., Maudoux A., Delhalle S., et al. Swallowing in individuals with disorders of consciousness: A cohort study. Ann Phys Rehabil Med. 2020; 18: 101403. DOI: 10.1016/j.rehab.2020.04.008.
- McRae J., Montgomery E., Garstang Z., Cleary E. The role of speech and language therapists in the intensive care unit. J. Intensive Care Soc. 2019; 21(4): 344–8. DOI: 10.1177/1751143719875687.
- Клинические рекомендации Союза реабилитологов России. «Клинико-психологическая диагностика и реабилитация пациентов с нарушениями регуляторных функций при повреждениях головного мозга» (полный текст на сайте: http://rehabrus.ru/index.php?id = 55). [Klinicheskie rekomendacii Soyuza reabilitologov Rossii. “Kliniko-psixologicheskaya diagnostika i reabilitaciya pacientov s narusheniyami regulyatorny`x funkcij pri povrezhdeniyax golovnogo mozga” (Full text available at: http://rehabrus.ru/index.php?id = 55). (In Russ)]
- Приказ Минздрава РФ от 31 июля 2020 г. N 788н об утверждении порядка организации медицинской реабилитации взрослых, Российская Федерация (2020). [Prikaz Minzdrava RF ot 31 iyulya 2020 g. N 788n ob utverzhdenii poryadka organizacii medicinskoj reabilitacii vzrosly`x, Rossijskaya Federaciya (2020). (In Russ)]
- Шелякин В.А., Белкин А.А., Алашеев А.М. и др. Мультидисциплинарная экспертиза как инструмент контроля качества медицинской помощи на этапах маршрутизации пациентам с острым нарушением мозгового кровообращения. Фарматека. 2018; 5: 60–5. DOI: 10.18565/pharmateca.2018.5.59–64. [Sheliakin V.A., Belkin A.A., Alasheev A.M., et al. Multidisciplinary expertise as a tool for medical care quality control at stages of routing of patients with acute cerebrovascular disorders. Farmateka. 2018; 5: 60–5. (In Russ)]
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2021 ANNALS OF CRITICAL CARE