Patients In Coma Research Articles

An Analysis of the Distribution of Glasgow Coma Scale Scores across Pan-Asian Trauma Outcomes Study (PATOS) Regions.

The Glasgow Coma Scale (GCS) was devised in 1974 as a way of tracking the progress of neurosurgical coma patients. It is comprised of three components: eye movement, response to verbal commands, and motor function. Since then, it has become the primary tool in Emergency Medical Services (EMS) and emergency departments for assessing cognitive function and triaging patients in the setting of acute trauma. However, the GCS was never intended to be used in such a way. It has been demonstrated that there is a high degree of inter-rater variability when assigning GCS scores for trauma patients. Potential differences in GCS score assignments between different countries were examined. It was hypothesized there would be differences in mean total and component scores. Using de-identified data from the Pan-Asian Trauma Outcomes Study (PATOS), the distributions of GCS scores from six countries were assessed: Japan, Korea, Malaysia, Taiwan, Thailand, and Vietnam. Using SPSS data analysis, a one-way ANOVA and Bonferroni post-hoc tests were performed to compare the means of the three GCS components and the total GCS scores reported by EMS personnel caring for trauma patients. Data from 15,173 cases showed significant differences in mean total GCS score between countries (P <.001) as well as in mean component GCS scores (P <.001 for each of eye, verbal, and motor). Post-hoc tests showed that EMS personnel in Korea assigned significantly lower scores compared to all other countries in both component and total GCS scores. Field personnel in Japan, Malaysia, and Vietnam assigned the highest scores and significantly differed from the other three countries on component and total scores; Thailand and Taiwan had similar scores but significantly differed from the other four countries on component and total scores. Visual inspection of mean component and total GCS score histograms revealed differences in score assignment patterns among countries. There are a number of significant differences in the mean total and component GCS scores assigned by EMS personnel in the six Asian countries studied. More investigation is necessary to determine if there is clinical significance to these differences in GCS score assignments, as well as the reasons for the differences.

The Effect of Sensory Stimuli With a Familiar Voice and Patient’s Auditory Preferences on the Level of Consciousness of Brain Injury Patients Admitted to Intensive Care Units

Background &amp; Aims: Most patients with brain injury experience coma based on the severity of the lesion. One of the complications that threaten patients with coma in intensive care units is the risk of sensory deprivation. Frequent sensory stimulation can be helpful in rehabilitation and increasing the level of consciousness of these patients. This study aimed to determine the effect of sensory stimuli with a familiar sound and patient’s auditory preferences on the level of consciousness of patients in coma admitted to intensive care units in selected hospitals in Ahvaz City, Iran. Materials &amp; Methods: The present study is quasi-experimental that was performed on 45 patients admitted to the intensive care unit of selected hospitals in Ahvaz City in 2021. Sampling was performed for six months. The patients who met the inclusion criteria were divided into two intervention groups and one control group by the permutation randomization method. For patients of the first group (hearing stimulation with a familiar voice) and the second group (auditory stimulation with the patient’s preference voice), recorded sound was played with a tape recorder for 15 minutes for 3 days twice a day (6 times in total) at 10 AM and 3 PM. Routine care and sounds were provided for the control group. The level of patients’ consciousness in three groups was measured by GCS scale 15 minutes before and 15 minutes after the intervention. Results: The study results showed that the mean level of consciousness of the auditory preferences and familiar voice groups after the intervention was significantly higher than that in the control group (P&lt;0.05). But there was no significant difference between the two groups of auditory preferences and familiar voice (P&gt;0.05). Conclusion: Considering that the effect of a familiar voice and auditory preferences has been more than unfamiliar sound, it is recommended to provide a program of auditory stimulation with familiar voices and auditory preferences for comatose patients in intensive care units.

The study of awakening stimulation on coma patients with severe head injury.

The study of awakening stimulation on coma patients with severe head injury.

Frequency of major causes of coma patients presented to emergency room of tertiary care hospitals with impaired conscious level, in Qassim region of Saudi Arabia.

Background: Disorders of consciousness including coma can be caused by a wide variety of etiologies affecting the central nervous system. Severity of coma may vary according to the causes of coma and patient’s characteristics. Objective: To determine frequency of major causes of coma patients presented to Emergency Department (ED) of tertiary care hospitals in Qassim region of Saudi Arabia. Methods: This retrospective audit study consisting of cases of coma, presented with impaired conscious level of any age and either gender admitted through ED of tertiary care hospitals in X region of Saudi Arabia over past 2 years. Patients with transient impairment of conscious level, pregnant women, referred cases of multiple organ failure and no clear etiological diagnosis on discharge were excluded from the study. After ethical approval, the data of the patients were collected retrospectively from the medical records on structured Proforma (Annexure-1). Results: Out of 422 patients of coma, 96 (22.7%) were observed with severely reduced GCS (≤8 score). About 2/3rd of patients had non-traumatic causes of coma (NTC) out of this cerebral infarction (16.4%) and metabolic brain dysfunction (15.6%) were the major causes in age group &gt;50 years. The most frequent single cause of altered mental status was traumatic brain injury (TBI) in 31% of cases with age group less the 40 years most affected 68%. Regarding the localization of coma, we observed; Diffuse brain dysfunction in 40% (n=169), Supra tentorial location in 44.8% (N=189) and infra tentorial localization in 15.2% (n=64) of cases, however the severe coma causes in older patients (&gt;60 years) were infratentorial stroke, CNS infection, brain metastasis and brain anoxia (p&lt;0.001). Conclusions: The leading cause of coma in our study in the age group less than 40 years was TBI about 68% of cases, but highly significant association of severe coma was found with older patients (&gt;60 years), infratentorial stroke, CNS infection, brain metastasis and brain anoxia.

New stage of scientific understanding of homeopathic phenomenon

Statements that homeopathy failed scientific testing and that it is a mock-science based on placebo effect are frequent in modern mass media. Their authors disregard not only results of many studies but also the effect of homeopathy in coma patients, infants, animals, germs and plants. Homeopathy is criticised due to lack of statistically acceptable studies and an accepted effect mechanism laid out in principles of modern science.&#x0D; &#x0D; However, homeopathy not only stood the time test but also showed potential for further implementation. Scientific studies, active use of homeopathy in medical practice help to resolve crisis in modern therapy by of treatment and prevention cost efficiency

A method to assess the default EEG macrostate and its reactivity to stimulation

ObjectiveThe default mode network (DMN) is deactivated by stimulation. We aimed to assess the DMN reactivity impairment by routine EEG recordings in stroke patients with impaired consciousness. MethodsBinocular light flashes were delivered at 1 Hz in 1-minute epochs, following a 1-minute baseline (PRE). The EEG was decomposed in a series of binary oscillatory macrostates by topographic spectral clustering. The most deactivated macrostate was labeled the default EEG macrostate (DEM). Its reactivity (DER) was quantified as the decrease in DEM occurrence probability during stimulation. A normalized DER index (DERI) was calculated as DER/PRE. The measures were compared between 14 healthy controls and 32 comatose patients under EEG monitoring following an acute stroke. ResultsThe DEM was mapped to the posterior DMN hubs. In the patients, these DEM source dipoles were 3–4 times less frequent and were associated with an increased theta activity. Even in a reduced 6-channel montage, a DER below 6.26% corresponding to a DERI below 0.25 could discriminate the patients with sensitivity and specificity well above 80%. ConclusionThe method detected the DMN impairment in post-stroke coma patients. SignificanceThe DEM and its reactivity to stimulation could be useful to monitor the DMN function at bedside.

Оказание скорой медицинской помощи пациентам в коматозном состоянии в г.Рязани в 2016–2020 гг.

The study objectives were to investigate the prevalence and to determine the most frequent causes of coma in patients in Ryazan; to determine the frequency of fatal outcomes at the stage of medical evacuation and the frequency of hospitalizations; to identify the features of emergency medical care in the prehospital period. Materials and methods. We analyzed statistical data on the number of witnesses who applied for emergency medical aid in cases of disturbance of consciousness in patients who were subsequently diagnosed as comatose patients; we revealed main causes and types of comatose states, number of fatal outcomes and frequency of hospitalizations in Ryazan. Materials of the study – cards of calls of ambulance crews in Ryazan in 2016-2020. Results of the study and their analysis. Analysis of statistical data for Ryazan in 2016-2020 showed a steady increase in the number of ambulance calls to patients in coma. In Ryazan, as in Russia as a whole, cerebral coma prevailed, with diabetic coma in second place and toxic coma – in third. In 2016-2020, the proportion of coma-related deaths was 2.7% in the prehospital period and had no upward trend. In 84% of cases patients were hospitalized in medical treatment organisations, patients with hypoglycemic coma sometimes refused hospitalization, there was no tendency in increase of the number of refusals. In the prehospital period, ambulance care for patients with coma was provided in accordance with the algorithms, average time to reach the call was 12.4 min, which corresponds to the respective norms for emergency calls for Ryazan.

Impact of rewarming rate on interleukin-6 levels in patients with shockable cardiac arrest receiving targeted temperature management at 33\xa0\xb0C: the ISOCRATE pilot randomized controlled trial

PurposeWhile targeted temperature management (TTM) has been recommended in patients with shockable cardiac arrest (CA) and suggested in patients with non-shockable rhythms, few data exist regarding the impact of the rewarming rate on systemic inflammation. We compared serum levels of the proinflammatory cytokine interleukin-6 (IL6) measured with two rewarming rates after TTM at 33 °C in patients with shockable out-of-hospital cardiac arrest (OHCA).MethodsISOCRATE was a single-center randomized controlled trial comparing rewarming at 0.50 °C/h versus 0.25 °C/h in patients coma after shockable OHCA in 2016–2020. The primary outcome was serum IL6 level 24–48 h after reaching 33 °C. Secondary outcomes included the day-90 Cerebral Performance Category (CPC) and the 48-h serum neurofilament light-chain (NF-L) level.ResultsWe randomized 50 patients. The median IL6 area-under-the-curve was similar between the two groups (12,389 [7256–37,200] vs. 8859 [6825–18,088] pg/mL h; P = 0.55). No significant difference was noted in proportions of patients with favorable day-90 CPC scores (13/25 patients at 0.25 °C/h (52.0%; 95% CI 31.3–72.2%) and 13/25 patients at 0.50 °C/h (52.0%; 95% CI 31.3–72.2%; P = 0.99)). Median NF-L levels were not significantly different between the 0.25 °C/h and 0.50 °C/h groups (76.0 pg mL, [25.5–3074.0] vs. 192 pg mL, [33.6–4199.0]; P = 0.43; respectively).ConclusionIn our RCT, rewarming from 33 °C at 0.25 °C/h, compared to 0.50 °C/h, did not decrease the serum IL6 level after shockable CA. Further RCTs are needed to better define the optimal TTM strategy for patients with CA.Trial registration ClinicalTrials.gov, NCT02555254. Registered September 14, 2015.Take-Home Message: Rewarming at a rate of 0.25 °C/h, compared to 0.50 °C, did not result in lower serum IL6 levels after achievement of hypothermia at 33 °C in patients who remained comatose after shockable cardiac arrest. No associations were found between the slower rewarming rate and day-90 functional outcomes or mortality.140-character Tweet: Rewarming at 0.25 °C versus 0.50 °C did not decrease serum IL6 levels after hypothermia at 33 °C in patients comatose after shockable cardiac arrest.

The Value of Comprehensive Resuscitation Nursing in Coma Patients after Severe Cerebral Hemorrhage

The Value of Comprehensive Resuscitation Nursing in Coma Patients after Severe Cerebral Hemorrhage

Prediction of patient survival following postanoxic coma using EEG data and clinical features.

Electroencephalography (EEG) is an effective and non-invasive technique commonly used to monitor brain activity and assist in outcome prediction for comatose patients post cardiac arrest. EEG data may demonstrate patterns associated with poor neurological outcome for patients with hypoxic injury. Thus, both quantitative EEG (qEEG) and clinical data contain prognostic information for patient outcome. In this study we use machine learning (ML) techniques, random forest (RF) and support vector machine (SVM) to classify patient outcome post cardiac arrest using qEEG and clinical feature sets, individually and combined. Our ML experiments show RF and SVM perform better using the joint feature set. In addition, we extend our work by implementing a convolutional neural network (CNN) based on time-frequency images derived from EEG to compare with our qEEG ML models. The results demonstrate significant performance improvement in outcome prediction using non-feature based CNN compared to our feature based ML models. Implementation of ML and DL methods in clinical practice have the potential to improve reliability of traditional qualitative assessments for postanoxic coma patients.

Therapeutic hypothermia after resuscitated cardiac arrest: benefits in survival and neurological outcome

Abstract Introduction The benefits of therapeutic hypothermia in patients remaining in coma after resuscitated cardiac arrest are still controversial, specially for nonshockable rhythm. This study aims to assess the effects of this technique in survival and neurological outcome in comatous patients after resuscitated cardiac arrest. Methods Retrospective analysis of patients admitted to a Coronary Care Unit from 2006 to 2020 who remained in coma (Glasgow Coma Scale ≤10) after resuscitated cardiac arrest. We compared intrahospital mortality and neurological outcome at discharge between patients who were treated with therapeutic hypothermia and those who weren't. We used intravascular cooling catheter with a target core temperature of 33°C, which was maintained for 24 hours. We performed a subgroup analysis to compare shockable and nonshockable rhythm. Neurological outcome was evaluated with the Cerebral Performance Categories Scale (CPC), which considers survival without limiting disability (CPC 1–2) as favourable neurological outcome. Results A total of 272 patients were admitted at our Coronary Care Unit after resuscitated cardiac arrest. 182 patients remained in coma after cardiac arrest. The median age was 65.83±0.98 years and 29.1% were women. 70 patients (38.46%) were treated with therapeutic hypothermia – 44 (62.85%) of them had shockable rhythm at presentation and 26 (37.14%), nonshockable rhythm. When we analysed all patients with shockable rhythm, mortality was significantly lower in those treated with therapeutic hypothermia (25% vs 53.8%, p=0.004). In nonshockable rhythm, there was a tendency for lower mortality in the hypothermia group (73.1% vs. 85%, p=0.19). Regarding neurological outcomes, we observed that therapeutic hypothermia also improved neurological outcome at discharge in patients with initial shockable rhythm (CPC 1–2 in 68.2% vs. 26.9%, p&amp;lt;0.001). On the other hand, more patients with nonshockable rhythm had a CPC 1–2 with this technique, although these results didn't reach statistical significance (19.2% vs. 10%, p=0.24). Conclusions According to our experience, therapeutic hypothermia in patients who remained in coma after resuscitated cardiac arrest showed favourable results in survival and neurological outcome both in shockable and nonshockable rhythm. Funding Acknowledgement Type of funding sources: None. Intrahospital MortalityGood neurological outcome at discharge

A Smart System to Ease Occurrence of Bedsores

The occurrence of bedsores in Ghanaian hospitals, elderly homes or care homes is especially high among patients or people who are incapacitated and cannot move or turn on their own, and who happen to remain in a particular posture for a very long time. Patients in coma, those operated on and for that matter in critical state, and patients confined to wheelchairs are primary examples. Constant pressure on some parts of the body leads to the occurrence of pressure sores or ulcers. This paper seeks to implement a Bedsore Easing System (BeSoSys) that integrate several embedded hardware components, a database and software to reduce the occurrence of bedsores. These embedded hardware components include the Bed Device Unit (BDU), the Pocket Device Unit (PDU), a pressure or weight sensor, a temperature sensor, and an inflation-deflation device. The BDU is fitted into the bed of the patient or on the surface of skin contact of the patient. The PDU is assigned to nurses or caretakers to serve as an alarm system for patient repositioning depending on situation. All activities in the Bedsore Easing System are logged into a database for future references. A bedridden patient exerts constant pressure on the bony protrusions of the body, and this causes bedsores. It was found out during the research that in Ghana, the nurses or caretakers used to turn and massage patients at some random time intervals as a way of preventing bedsores. This traditional way of turning and massaging patients is not only tedious but also ineffective. This paper seeks to provide easy, better, and effective solution to ease bedsores. The BeSoSys intends to prevent the occurrence of bedsores hence the alleviation of bedsore complications

Prognostication of patients in coma after cardiac arrest: Public perspectives

AimTo elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. MethodsA web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for differences between countries. ResultsIn total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37–54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). ConclusionsOver one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests.

EEG Abnormalities and Their Radiographic Correlates in a COVID-19 Inpatient Cohort.

To identify the prevalence of EEG abnormalities in patients with coronavirus disease 2019 (COVID-19) with neurologic changes, their associated neuroimaging abnormalities, and rates of mortality. A retrospective case series of 192 adult COVID-19-positive inpatients with EEG performed between March and June 2020 at 4 hospitals: 161 undergoing continuous, 24 routine, and 7 reduced montage EEG. Study indication, epilepsy history, intubation status, administration of sedatives or antiseizure medications (ASMs), metabolic abnormalities, neuroimaging pathology associated with epileptiform abnormalities, and in-hospital mortality were analyzed. EEG indications included encephalopathy (54.7%), seizure (18.2%), coma (17.2%), focal deficit (5.2%), and abnormal movements (4.6%). Epileptiform abnormalities occurred in 39.6% of patients: focal intermittent epileptiform discharges in 25.0%, lateralized periodic discharges in 6.3%, and generalized periodic discharges in 19.3%. Seizures were recorded in 8 patients, 3 with status epilepticus. ASM administration, epilepsy history, and older age were associated with epileptiform abnormalities. Only 26.3% of patients presented with any epileptiform abnormality, 37.5% with electrographic seizures, and 25.7% patients with clinical seizures had known epilepsy. Background findings included generalized slowing (88.5%), focal slowing (15.6%), burst suppression (3.6%), attenuation (3.1%), and normal EEG (3.1%). Neuroimaging pathology was identified in 67.1% of patients with epileptiform abnormalities, over two-thirds acute. In-hospital mortality was 39.5% for patients with epileptiform abnormalities and 36.2% for those without. Risk factors for mortality were coma and ventilator support at time of EEG. This article highlights the range of EEG abnormalities frequently associated with acute neuroimaging abnormalities in COVID-19. Mortality rates were high, particularly for patients in coma requiring mechanical ventilation. These findings may guide the prognosis and management of patients with COVID-19 and neurologic changes.

Prognostic significance of hypernatremia in altered sensorium

Early prediction of prognosis of patients in coma depends on numerous factors and remains a challenge to the physician. We sought to assess if prediction of mortality during hospital stay was improved by including clinical or biochemical parameters that could be easily obtained on arrival in the Emergency Department.

Efficacy of olfaction vs oral route of administration in acute diseases: Pilot study

Over the years, the oral route has been the preferred way of taking medication. There are cases in children and coma patients where olfaction is required, and Hahnemann is well aware that patients are advised to smell in many situations. Medication given this way usually works faster. The olfactory experience is subjective and the olfactory nerves are specific. Based on inclusion and exclusion criteria volunteers were selected and divided into 2 groups of oral and olfaction of 15 matched patients. Potency of remedy was based on totality of symptoms and susceptibility and according to the need of the patient, repetition was also done. Time taken for drug action and improvement of condition considered and recorded for adaptability. Data obtained statistically analyzed. The results thus obtained explain the benefit of olfaction over oral route of administration of the drug.

Organ Transplant in Present-Day Japan: Reasons behind Low Numbers of Deceased Donors

According to the International Register of Organ Donation and Transplantation, Japan is one of the countries with the lowest number of registered deceased donors. In 2019, Japan was ranked 61st out of 70 countries. The authors of this article have decided to explore the reasons for this phenomenon. In the first part of the work, religious influences (Shinto and Buddhism), the tradition of gotai manzoku, the importance of altruism and the family in the perception of death and organ transplantation by the Japanese are considered. The second part of the article presents the arguments of Alan Shewmon, who believes that brain death is not death in the biological sense. Undermining the brain’s death criterion raises doubts concerning death of patients in irreversible coma, what in result discourages transplantology in Japan. In the third part, the authors compare the results of JOTN, IRODaT and the Fact Book of Organ Transplantation 2018 in Japan from 2010 to 2018. The aim of the article is to explain the cultural determinants of transplantology in Japan, taking into account the influence of philosophical and bioethical aspects of human death.

Treatment of Patients in Coma and Exercises for Enhancing Cognitive Functions after Traumatic Brain Injury

The neuropsychological training methods for the restoration of sensory losses after a TBI aim both at the restoration of the sensory losses and at the practice of the other senses to "compensate" for the dysfunctional sensation. Aim: The purpose of the study was to present treatment of patients in coma and exercises for enhancing cognitive functions after traumatic brain injury. Results: Electronically assisted treatment methods (Computer - Assisted Treatment, CAT) are now recognized methods, with high success rates in the rehabilitation of patients after TBI. Conclusions: Cognitive rehabilitation must be done taking into account a variety of neurofunctional abilities and weaknesses. Basic skills need to be stimulated before any approach to more complex ones can be made. The use of audiovisual media in general contributes both to the restoration of vision and compensatory restoration of functions as well as to the general restoration of the patient's cognitive functions. Cognitive rehabilitation to recover and improve attention and memory, offers a variety of different types of exercises for specific disorders. Exercise can vary in degree of difficulty depending on the patient's needs.

Клинический случай молочнокислой комы с летальным исходом у пациентки с сахарным диабетом 2-го типа

At the moment, lactate-acidosis coma in patients with diabetes mellitus is considered a rare and extremely urgent condition that occurs in patients with concomitant diseases as well as when taking the most widely used sugar reducing drug – metformin. This article describes a case of lactate-acidosis coma with a fatal outcome, which occurred against the background of taking metformin and alcohol abuse, in a woman with type 2 dia-betes mellitus aged 48 years.

Nursing assessment of incidence and types of complications of coma patients.

Nursing assessment of incidence and types of complications of coma patients.