Chronic Disorders of Consciousness: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”
Issue 3 (2023) , CLINICAL GUIDELINES
Issue 3 (2023)
CLINICAL GUIDELINES

Chronic Disorders of Consciousness: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”

https://doi.org/10.21320/1818-474X-2023-3-7-42
Published 28.07.2023
A.A. Belkin
Clinical Institute of Brain, Yekaterinburg, Russia; Ural State Medical University, Yekaterinburg, Russia
https://orcid.org/0000-0002-0544-1492
E.V. Aleksandrova
National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Russia
https://orcid.org/0000-0001-5327-314X
T.V. Akhutina
Lomonosov Moscow State University, Moscow, Russia
https://orcid.org/0000-0002-8503-2495
V.A. Belkin
Clinical Institute of Brain, Yekaterinburg, Russia
https://orcid.org/0000-0002-4043-743X
E.S. Berdnikovich
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0003-1044-6009
V.I. Bykova
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russia
https://orcid.org/0000-0003-4473-499X
N.A. Varako
Lomonosov Moscow State University, Moscow, Russia; Research Center of Neurology, Moscow, Russia; Psychological Institute of the Russian Academy of Education, Moscow, Russia
https://orcid.org/0000-0002-8310-8169
I.A. Voznyuk
I.I. Dzhanelidze Research Institute of Emergency Care, St. Petersburg, Russia
https://orcid.org/0000-0002-0340-4110
E.V. Gnedovskaya
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0001-6026-3388
V.N. Grigoryeva
Privolzhsky Research Medical University, Nizhny Novgorod, Russia
https://orcid.org/0000-0002-6256-3429
O.S. Zaytsev
National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Russia
https://orcid.org/0000-0003-0767-879X
Yu.P. Zinchenko
Lomonosov Moscow State University, Moscow, Russia
https://orcid.org/0000-0002-9734-1703
G.E. Ivanova
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0003-3180-5525
N.E. Ivanova
Polenov Neurosurgical Institute, St. Petersburg, Russia
https://orcid.org/0000-0003-2790-0191
M.S. Kovyazina
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
https://orcid.org/0000-0002-1795-6645
A.N. Kondratyev
Polenov Neurosurgical Institute, St. Petersburg, Russia
https://orcid.org/0000-0002-7648-2208
E.A. Kondratyeva
Military Medical Academy, St. Petersburg, Russia
https://orcid.org/0000-0001-6362-6543
S.A. Kondratyev
Polenov Neurosurgical Institute, St. Petersburg, Russia
https://orcid.org/0000-0001-5028-5938
V.V. Krylov
N.V. Sklifosovskii Research Institute for Emergency Medicine of Moscow Healthcare Department, Moscow, Russia
https://orcid.org/0000-0003-4136-628X
Ya.A. Latyshev
National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Russia
https://orcid.org/0000-0002-7125-5962
K.M. Lebedinskii
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
https://orcid.org/0000-0002-5752-4812
L.A. Legostaeva
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0001-7778-6687
O.A. Maksakova
National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Russia
https://orcid.org/0000-0002-4781-2765
M.Yu. Martynov
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0003-2797-7877
Yu.V. Mikadze
Lomonosov Moscow State University, Moscow, Russia
https://orcid.org/0000-0001-8137-9611
S.S. Petrikov
N.V. Sklifosovskii Research Institute for Emergency Medicine of Moscow Healthcare Department, Moscow, Russia
https://orcid.org/0000-0003-3292-8789
M.V. Petrova
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
https://orcid.org/0000-0003-4272-0957
M.A. Piradov
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0002-6338-0392
K.A. Popugaev
N.V. Sklifosovskii Research Institute for Emergency Medicine of Moscow Healthcare Department, Moscow, Russia
https://orcid.org/0000-0003-1945-323X
I.V. Pryanikov
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
https://orcid.org/0000-0003-3792-9107
Yu.V. Ryabinkina
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0001-8576-9983
I.A. Savin
National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Russia
https://orcid.org/0000-0003-2594-5441
Dmitry V. Sergeev
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0002-9130-1292
M.V. Sinkin
N.V. Sklifosovskii Research Institute for Emergency Medicine of Moscow Healthcare Department, Moscow, Russia
https://orcid.org/0000-0001-5026-0060
A.A. Skvortsov
National Research University Higher School of Economics, Moscow, Russia
https://orcid.org/0000-0002-0471-4217
E.Yu. Skripay
National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Russia
https://orcid.org/0000-0002-5311-7371
A.Yu. Suvorov
Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
https://orcid.org/0000-0003-4901-2208
N.A. Suponeva
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0003-3956-6362
D.Yu. Usachev
National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Russia
https://orcid.org/0000-0002-9811-9442
E.V. Fufaeva
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russia
https://orcid.org/0000-0002-7556-0745
N.A. Shamalov
Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
https://orcid.org/0000-0001-6250-0762
A.V. Shchegolev
Military Medical Academy, St. Petersburg, Russia
https://orcid.org/0000-0001-6431-439X
E.G. Iazeva
Three Sisters Rehabilitation Center, Moscow region, Moscow, Russia
https://orcid.org/0000-0003-0382-7719
I.B. Zabolotskikh
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; Kuban State Medical University, Krasnodar, Russia
https://orcid.org/0000-0002-3623-2546
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Keywords

coma
chronic disorders of consciousness
prolonged disorders of consciousness
vegetative state
minimally conscious state
rehabilitation

How to Cite

Belkin A.A., Aleksandrova E.V., Akhutina T.V., Belkin V.A., Berdnikovich E.S., Bykova V.I., Varako N.A., Voznyuk I.A., Gnedovskaya E.V., Grigoryeva V.N., Zaytsev O.S., Zinchenko Y.P., Ivanova G.E., Ivanova N.E., Kovyazina M.S., Kondratyev A.N., Kondratyeva E.A., Kondratyev S.A., Krylov V.V., Latyshev Y.A., Lebedinskii K.M., Legostaeva L.A., Maksakova O.A., Martynov M.Y., Mikadze Y.V., Petrikov S.S., Petrova M.V., Piradov M.A., Popugaev K.A., Pryanikov I.V., Ryabinkina Y.V., Savin I.A., Sergeev D.V., Sinkin M.V., Skvortsov A.A., Skripay E.Y., Suvorov A.Y., Suponeva N.A., Usachev D.Y., Fufaeva E.V., Shamalov N.A., Shchegolev A.V., Iazeva E.G., Zabolotskikh I.B. Chronic Disorders of Consciousness: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”. Annals of Critical Care. 2023;(3):7–42. doi:10.21320/1818-474X-2023-3-7-42.
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Abstract

Chronic disorders of consciousness (DOC) represent severe central nervous system damage resulting in long-term disability and a significant burden to healthcare institutions and patientsʼ families. DOC develop in patients after coma and are characterized by the presence of wakefulness with complete or almost complete absence of signs of awareness. DOC include vegetative state (VS) and minimally conscious state (MCS). The term prolonged disorders of consciousness (pDOC) is also used in the Russian literature to describe the initial stages of chronic DOC. Another clinical entity, exit from MCS, is used to characterize the stage of recovery of cognitive functions. Diagnosis of DOC is based on repeated structured clinical examination using specific scales, provided that reversible causes of impaired consciousness are excluded. Treatment of DOC patients includes maintenance of vital functions and optimal nutrition and control of typical complications and concomitant conditions (pressure sores, spasticity, pain, paroxysmal sympathetic hyperactivity, etc.). Rehabilitation of DOC patients should involve a multidisciplinary rehabilitation team, the extent of which is determined by the individual problems and capabilities of the patient. Rehabilitation is most effective if started early. To date, there is no robust evidence on the effectiveness of specific methods for restoring consciousness, while a number of pharmacological and non-pharmacological interventions are being studied; however, they should be applied provided that the maximum possible level of correction of the patientʼs somatic problems is achieved. The family plays a key role in rehabilitation. They need practical information about their loved oneʼs condition, guidance in rehabilitation, and psychological support.

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