Conscious Patients Research Articles

Minimally Invasive Puncture and Drainage Surgery for the Treatment of Thalamic Hemorrhage Guided by a 3D-printed Guide Plate.

Thalamic hemorrhage is a type of intracerebral hemorrhage with high disability and mortality rates. Because of its deep bleeding location, irregular shape of the hematoma, and compression of the third ventricle, it is not suitable for craniotomy. This paper reports a case of a 63-year-old male patient who sought medical attention for left-sided basal ganglia and thalamus hemorrhage that broke into the ventricles. Upon admission, the patient exhibited impaired consciousness and was diagnosed with thalamic hemorrhage accompanied by ventricular hemorrhage through the head CT and CTA scan. To address the patient's unique circumstances, a 3D-printed guide plate was utilized to guide the puncture and drainage surgery, thereby ensuring a relatively smooth and less traumatic process. After the surgery, the patient's consciousness recovered well, and there was significant improvement in clinical indicators. This case demonstrates that a 3D-printed guide plate has the advantage of precise localization and minimal trauma in guiding thalamic hemorrhage surgery, showing promising clinical application prospects and being worthy of promotion in future clinical practice.

Lidocaine 2% and Xylocaine Spray as A Combination in Successful Awake Intubation in Difficult Airway: How to Do it?

Awake intubation is a technique used to insert an endotracheal tube while maintaining the patient's consciousness. It is particularly beneficial for patients with difficult airway anatomy, as it allows better visualization using a fiber optic bronchoscope, reduces discomfort with local anesthesia, and ensures the preservation of spontaneous breathing. This approach is critical in high-risk procedures such as total thyroidectomy. This case report aims to describe the application of awake intubation in a high-risk patient undergoing total thyroidectomy due to a thyroid mass causing tracheal narrowing. A 47-year-old female with airway management difficulties (LEMON 3/10, MOANS 0/5) was scheduled for a 3–4-hour total thyroidectomy. Preoperative preparation included fasting, informed consent, and ensuring complete anesthesia equipment. Airway preparation involved Xylocaine spray and Lidocaine nebulization, followed by premedication with Dexamethasone, Diphenhydramine, and Midazolam. Induction was achieved using Propofol, and intubation was performed with an endotracheal tube guided by a fiber optic bronchoscope. Maintenance of anesthesia utilized Oxygen, Sevoflurane, and Atracurium. The results show the patient tolerated the awake intubation procedure well, with no episodes of desaturation or significant bleeding during surgery. Postoperative management included analgesia with Fentanyl and Ketamine, as well as respiratory therapy intervention (RTI) during recovery. Awake intubation, combined with effective airway preparation and anesthesia protocols, provides a safe and reliable approach for managing patients with difficult airways, particularly in high-risk procedures like total thyroidectomy. The technique ensured patient comfort, maintained oxygenation, and minimized perioperative complications.

Best Interests and Decisions to Withdraw Life-Sustaining Treatment from a Conscious, Incapacitated Patient.

Conscious but incapacitated patients need protection from both undertreatment and overtreatment, for they are exceptionally vulnerable, and dependent on others to act in their interests. In the United States, the law prioritizes autonomy over best interests in decision making. Yet U.S. courts, using both substituted judgment and best interests decision making standards, frequently prohibit the withdrawal of life-sustaining treatment from conscious but incapacitated patients, such as those in the minimally conscious state, even when ostensibly seeking to determine what patients would have wanted. In the United Kingdom, under the Mental Capacity Act of 2005, courts decide on the best interests of incapacitated patients by, in part, taking into account the past wishes and values of the patient. This paper examines and compares those ethicolegal approaches to decision making on behalf of conscious but incapacitated patients. We argue for a limited interpretation of best interests such that the standard is properly used only when the preferences of a conscious, but incapacitated patient are unknown and unknowable. When patient preferences and values are known or can be reasonably inferred, using a holistic, all-things-considered substituted judgment standard respects patient autonomy.

The Role of Ultrasonographic Assessment of Optic Nerve Sheath Diameter in Prediction of Sepsis-Associated Encephalopathy: Prospective Observational Study.

Ultrasonographic optic nerve sheath diameter (ONSD) is a satisfactory noninvasive intracranial pressure (ICP) monitoring test. Our aim was to evaluate ONSD as an objective screening tool to predict and diagnose ICP changes early in sepsis-associated encephalopathy (SAE). Our prospective observational study was conducted on patients with sepsis, and after intensive care unit (ICU) admission, the time to diagnose SAE was recorded, and patients were divided into a non-SAE group including conscious patients with sepsis and a SAE group including patients with sepsis with acute onset of disturbed conscious level. ONSD was measured within 24h of ICU admission for all patients and then every other day for up to 10 consecutive days until ICU discharge or death. The primary outcome was to compare ONSD measurements of both groups to find if there was a correlation between ONSD and SAE occurrence. Eighty-nine patients with sepsis were divided into a non-SAE group (n = 45) and an SAE group (n = 44). ONSD showed a statistically significant difference at day 0 and a highly significant difference at days 2, 4, 6, 8, and 10. Day 2 ONSD had the best accuracy for predicting SAE, with a cutoff > 5.2mm (sensitivity of 93.2%, specificity of 100%), a statistically positive correlation with the Sequential Organ Failure Assessment score (r = 0.485, P < 0.001) and ICU length of stay (r = 0.238, P < 0.001), and a statistically significant wider in patients who died compared to those who survived (P < 0.001). ONSD could be an objective screening method for early diagnosis of SAE, with a cutoff > 5.2mm. Trial registration NCT05849831 ( https://clinicaltrials.gov/study/NCT05849831 ).

Central Catheter Complicated with Fatal Pulmonary Embolism in a Patient under Chronic Hemodialysis: A Case Report

Introduction: The use of central venous catheter is a common practice in hemodialysis in Mali. Its use exposes to risks such as infection, stenosis, thrombosis among others. Pulmonary embolism is a rare but serious complication. The aim of our work was to offer advice on the diagnosis, risk factors, treatment and prevention of deep vein thrombosis following the placement of a central catheter. Observation: This was a 56-year-old woman, a housewife living in the city of Bamako. She had been on chronic hemodialysis for 6 months due to nephroangiosclerosis, at a rate of two four-hour sessions per week through a right femoral catheter. Before her hospitalization, she had a fever, physical asthenia, anorexia, a feeling of heavy leg on the right and abdominal pain. The clinical examination found a conscious patient, with little color and normal parameters, a swelling of the right leg with pain and redness. The biological assessment revealed hypochromic microcytic anemia, Procalcitonin at 2.75ng/l. The Doppler of the right lower limb confirmed deep vein thrombosis. The pulsed cardiac Doppler and the ECG confirmed the diagnosis of pulmonary embolism. Curative treatment of venous thrombosis was started. The immediate aftermath was marked by respiratory problems requiring oxygen therapy, acute circulatory failure syndrome with coldness of the extremities. The outcome was unfavorable with the death of the patient. Conclusion: The use of central venous catheter for hemodialysis as first-line treatment remains frequent in Mali. Patients should benefit from increased monitoring and prophylactic treatment to prevent the occurrence of thromboembolic events.

Words to Avoid During Wide-awake Local Anesthesia No Tourniquet Surgery to Enhance Patient Experience.

In the evolving landscape of ambulatory surgery, wide-awake local anesthesia no tourniquet (WALANT) surgery has emerged as a preferred approach due to its efficacy, cost-effectiveness, and patient satisfaction. This paradigm shift places the patient at the center of intraoperative communication, requiring a significant change in the dialogue within the operating room (OR). Traditional conversations, which often exclude the unconscious patient, must evolve to accommodate and prioritize the psychological comfort of the conscious patient. This article examines the impact of language, tone, and conversation content on the patient experience during WALANT. We propose a communication framework that emphasizes empathy, reassurance, and patient inclusion to reduce anxiety and increase patient compliance. By analyzing common OR dialogues and their potential impact on awake patients, we identify specific phrases and words that may exacerbate patient stress or discomfort. Alternatives are suggested to foster a more positive and inclusive environment. Our recommendations are based on extensive clinical experience and supported by relevant literature, highlighting the critical role of mindful communication in improving clinical outcomes and patient satisfaction in WALANT.

Complex auditory regularity processing across levels of consciousness in coma: Stage 1 Registered Report.

A key question for the scientific study of consciousness is whether it is possible to identify specific features in brain activity that are uniquely linked to conscious experience. This question has important implications for the development of markers to detect covert consciousness in unresponsive patients. In this regard, many studies have focused on investigating the neural response to complex auditory regularities. One noteworthy example is the local global paradigm, which allows for the investigation of auditory regularity encoding at the 'global' level, based on the repetition of groups of sounds. The inference of global regularities is thought to depend on conscious access to such complex auditory stimuli as mostly shown in chronic stages of disorders of consciousness patients. However, whether global regularity encoding can identify covert consciousness along the consciousness spectrum including earlier stages of these disorders remains controversial. Here, we aim to fill this gap by investigating whether the inference of global auditory regularities can occur in acute coma, in the absence of consciousness, and how this may be modulated by the severity of the patients' clinical condition and consciousness level measured using the Full Outline of UnResponsiveness (FOUR) score. We will acquire 63-channel continuous electroencephalography to measure the neural response to global auditory regularity in comatose patients (N = 30) during the first day after cardiac arrest, when patients are unconscious, sedated and under normothermia, and during the second day (with reduced or absent sedation and body temperature control). We hypothesize that global regularity encoding will persist in the absence of consciousness independent of patient outcome, observed as above chance decoding of the neural response to global regularities using multivariate decoding analyses. We further hypothesize that decoding performance will positively correlate with the FOUR score, which indexes consciousness level, and typically improves between the first and second day after coma onset following cardiac arrest in patients with favourable outcome. In an exploratory analysis, we will also evaluate whether global regularity encoding may be influenced by the patients' clinical management, specifically sedation, also shown to affect global deviance detection. Our results will shed light on the neurophysiological correlates of complex auditory regularity processing in unconscious patients and on the link to residual levels of consciousness during the underexplored state of coma upon the first days after cardiac arrest.

Communication Methods Used with Conscious Intubated Patients: Scoping Review

Background Intubated conscious patients often experience communication difficulties. The present narrative review outlines the current evidence on communication methods adopted and the experience of conscious intubated patients in critical care areas. Objectives To our knowledge, studies have attempted to examine communication with conscious intubated patients. The present review had two objectives: (1) to identify the methods adopted by nurses and conscious intubated patients to ease the communication difficulties faced due to intubation and (2) to identify the experience of nurses and conscious intubated patients with the adopted communication methods. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was followed throughout this review. PubMed and ProQuest databases were searched with the terms “intubated conscious patients,” “communication,” and “nurse”, including original research articles published between January 2019 and May 2024 on conscious patients needing intubation. Dissertations, review papers, non-interventional research, and articles written in languages other than English were excluded. Only eight of the original 2,041 studies, which included 137 intubated patients and for 545 nurses, met the inclusion criteria. The authors used the Mixed Method Appraisal tool (MMAT) and the Critical Appraisal Skills Program (CASP) to collect data and assess quality. Results After the first search of generated 2041 papers, only eight articles—representing various studies—were able to meet the inclusion requirements. The included studies were six (6) quantitative, one (1) qualitative study and one (1) mixed-method study. Four communication intervention types were identified, namely: (1) Communication boards/charts (two studies), which improved communication and increased patient satisfaction. (2) Gestures and facial expressions (four studies) were reported to be frequently initiated for communication by the nurses with the patients. (3) Multiple methods (three studies) used were found to be insufficient to communicate with the patients. (4) Digital technology program, including Communicative Digital Technology Program was found to be effective means of communication in three such studies. Conclusion Results imply that communication techniques may be useful in enhancing patient–nursing professional communication with conscious intubated patients. However, in developing countries with fewer resources, a low-cost communication tool addressing both physical and emotional needs may be developed to aid in communication among patients and nurses.

Communication Experiences of Conscious Indonesian Patients Who Underwent Mechanical Breathing in an Intensive Care Unit: A Phenomenological Approach

Background: Mechanical ventilation is equipment used by patients in ICU. These patients may experience stress due to inadequate communication, including psycho-emotional pressure with a tendency to depression, anxiety, and frustration. It is important to facilitate effective communication during mechanical ventilation to monitor these patients. Nursing staff need to understand patients regarding their inability to communicate. The installation of mechanical ventilation is a barrier to nurse-patient communication. The culture in which a person lives has an impact on their health-related attitudes and behaviors. Thus, this study aims to determine the experience of the communication needs of conscious patients with experience of mechanical ventilation in ICU. Methods: The research method uses qualitative research with a phenomenological approach. The population in this study were former ICU patients with experience mechanical ventilation who were conscious. The sampling of informants was carried out using a purposive method. This study involved three research informants of various ages. This research was conducted in Yogyakarta, a province of Indonesia. Data collection used in-depth interviews. Data analysis in this study used the Colaizzi method to generate themes. Results: The themes obtained in this study were experience of discomfort disturbance in mechanically ventilated conscious patients; mechanically ventilated patients' communication perceptions; the need for social interaction when mechanically ventilated; and the beliefs experienced by patients while unconscious in ICU. We found a new insight that trusting something the patient has experienced is something that needs to be respected. When patients were unconscious, all participants experienced a spiritual journey that brought them into a state of belief about the dying phase. Conclusion: Communication between patients and nurses is beneficial in providing better nursing care following patient needs. This communication is also needed for patients with mechanical ventilation in ICU. It shows the importance of communication between mechanically ventilated patients and nurses in ICU.

Exploring end-of-life decision-making in China for disorders of consciousness

Objectives We aim to investigate the ethical attitudes of the Chinese population toward withdrawal of life-sustaining treatment (WLST) in disorders of consciousness (DoC) patients. Methods A self-administered questionnaire concerning WLST was distributed to Chinese medical professionals and non-medical participants between February and July 2022. Statistical analysis included chi-square tests and logistic regressions. Results A total of 1223 Chinese participants responded to the questionnaire (39% of whom were medical professionals). Less than one third of participants reported positive attitudes towards withdrawing artificial nutrition and hydration (ANH), antibiotics, and do-not-resuscitation (DNR) orders in patients with unresponsive wakefulness syndrome (UWS) (30%, 24%, 24%) and minimally conscious state (MCS) (23%, 19%, 15%). More respondents agreed with WLST in UWS compared to MCS (p < 0.05). Positive attitudes toward DNR orders were associated with participants’ older age, religion, monthly income > 5000 RMB and medical profession (p < 0.05). Most participants deemed patient’s will (78%), families’ wishes (67%), and financial burden (63%) to be crucial factors when considering WLST. Conclusions Chinese respondents exhibit a relatively low propensity to accept WLST in DoC. Ethical attitudes toward WLST resulted to be affected by individual characteristics of responders. These results call for developing better regulations for identifying qualified surrogate decision-makers and reducing legal ambiguities.

Acute Traumatic Epidural Hematoma in Geriatri, case report

Acute epidural haematomas (AEDH) are rare cases in geriatric age group as the dura adheres firmly to the inner table of the cranial bone. Trauma Brain Injuries are attributed to several mechanisms of injury, including falls, motor vehicle or other types of road injuries, sports-related injuries, and interpersonal physical violence or violence by other means (e.g., blast injury). Presentation may range widely from normal mental status to severe intracerebral injury in the elderly although acute deterioration may occur in previously conscious patients. There are only a few studies in the literature concerning acute epidural haematomas in geriatric age group. In our case, a 66-year-old male patient with cranial Computerized Tomography (CT) showed AEDH at the right parietotemporooccipital region.

Abstract 4141488: Initial Real-World Experience with a Novel Wearable Cardioverter Defibrillator

Background: The wearable cardioverter defibrillator (WCD) can reduce sudden cardiac death; effectiveness depends on adherence. A novel WCD designed for sex specific comfort and noise immunity has reported improved compliance. Hypothesis: Patient compliance with the WCD maximizes device utility in treating significant arrhythmia. Aims: Report WCD patient compliance and efficacy in a cohort with balanced gender representation. Evaluate WCD performance in minimizing noise artifact leading to false alarms and unnecessary shocks. Methods: Retrospective analysis of patients prescribed the ASSURE WCD at the Cleveland Clinic. Clinical data was collected via medical chart review. All device-detected arrhythmia episodes were manually adjudicated by a Board-certified Electrophysiologist. Detected rhythms that persist, result in an audible alarm notifying that a shock is imminent. A conscious patient can manually divert a shock. An alarm was deemed true and shock appropriate if the underlying rhythm was sustained VT/VF. Results: Fifty-five patients were fitted with a WCD. Median daily use 22 hr/day (IQR 13,24) and median duration of use 43 days (IQR 8,79). Female representation was 49%, significantly greater than prior reports of WCD experience. 4 episodes of sustained VT/VF were detected in 4 patients. A single shock terminated VT/VF in 2, while spontaneous termination of VT/VF occurred in the other 2 patients who diverted shocks. One shock for hemodynamically unstable atrial fibrillation with heart rate &gt;200bpm was delivered and deemed necessary. No deaths occurred while wearing a WCD. Of 163 recorded episodes, 62 (38%) persisted and triggered an alarm (Figure 1). 10 patients experienced a median of 1 (IQR 1,9.5) alarm during the WCD wear period. The majority (97%) of alarms were associated with a significant tachyarrhythmia, with only 3% due to noise artifact. No inappropriate, unnecessary shocks were delivered. Discussion: Patient compliance with the ASSURE WCD was high in this real-world observational study with equal representation of both sexes. The WCD effectively terminated sustained hemodynamically significant tachyarrhythmias, emitted few false alarms due to noise and resulted in no unnecessary and inappropriate shocks.

Comparison of Adequacy of Anaesthesia (AoA) monitors with CONOX® monitor regarding sevoflurane consumption during routine general anaesthesia: A randomised clinical trial.

Adequacy of Anaesthesia (AoA) and CONOX® are combined monitors that assess levels of anaesthesia and analgesia and give a comprehensive score. No studies have measured and compared the total consumption of inhaled anaesthetic agents while using these monitors. We designed a study to compare AoA and CONOX in terms of sevoflurane usage, fentanyl usage and recovery from the effects of anaesthesia. A randomised trial was conducted in 58 patients. Group A (n = 31) patients were monitored with AoA, and Group C (n = 27) patients were monitored with CONOX. Sevoflurane was titrated to maintain a state entropy value of 40-60 in AoA and a Quantium consciousness index (qCON) value of 40-60 in CONOX. Similarly, fentanyl was titrated with bolus doses of 0.5 μg/kg to maintain a surgical pleth index value of 40-60 in AoA and Quantium noxious index (qNOX) value of 40-60 in CONOX. Intraoperative awareness was assessed postoperatively using a modified Brice questionnaire. The t-test or Chi-square test was used to compare the parameters between the groups. Mean sevoflurane consumption was similar between AoA and CONOX groups [13.2 (standard deviation {SD}: 3.9) (95% confidence interval {CI}:11.8, 14.5) versus 14.4 (SD: 3.7) (95% CI: 13.0, 15.7) ml/h] (P = 0.236). Fentanyl usage was higher in the AoA group compared to the CONOX group [146.2 (SD: 34.28) (95% CI: 134.13, 158.26) versus 128.2 (SD: 26.7) (95% CI: 118.12, 138.27) μg] (P = 0.031). The emergence time and haemodynamic instability events were similar between AoA and CONOX. Both AoA and CONOX measure anaesthetic depth similarly. However, interpreting qNOX values requires caution, as the patient's consciousness status influences them.

Open Trauma to the Larynx by a Stab Wound: A Case Report

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Open laryngeal trauma is rare. Only early and appropriate diagnosis and treatment can preserve or restore the respiratory and phonatory functions of the larynx and prevent the appearance of disabling functional sequelae. &amp;lt;i&amp;gt;Material and method&amp;lt;/i&amp;gt;: This was a 50-year-old patient with a history of psychiatric illness, admitted for treatment of a penetrating wound to the neck following an attempted self-lysis with a bladed weapon (knife). On examination, we objectified a conscious patient with a makeshift bandage soiled with blood at the neck. A respiratory murmur was also perceived. Given this picture, the patient was immediately taken in a lying position to the operating room for surgical management. The postoperative course was marked on D13 by a decannulation process and a complete decanution on D15 postoperatively. We proceeded to remove the nasogastric tube on D21. A cure without respiratory or vocal sequelae was obtained on D28 postoperatively. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Open trauma is a diagnostic and therapeutic emergency. If unrecognized or poorly managed, it can be life-threatening in the immediate term or cause serious long-term after-effects.

Impact of sleep disturbances on outcomes in intensive care units

BackgroundSleep deprivation is common in intensive care units (ICUs) and may alter respiratory performance. Few studies have assessed the role of sleep disturbances on outcomes in critically ill patients.ObjectivesWe hypothesized that sleep disturbances may be associated with poor outcomes in ICUs.MethodsPost-hoc analysis pooling three observational studies assessing sleep by complete polysomnography in 131 conscious and non-sedated patients included at different times of their ICU stay. Sleep was assessed early in a group of patients admitted for acute respiratory failure while breathing spontaneously (n = 34), or under mechanical ventilation in patients with weaning difficulties (n = 45), or immediately after extubation (n = 52). Patients admitted for acute respiratory failure who required intubation, those under mechanical ventilation who had prolonged weaning, and those who required reintubation after extubation were considered as having poor clinical outcomes. Durations of deep sleep, rapid eye movement (REM) sleep, and atypical sleep were compared according to the timing of polysomnography and the clinical outcomes.ResultsWhereas deep sleep remained preserved in patients admitted for acute respiratory failure, it was markedly reduced under mechanical ventilation and after extubation (p < 0.01). Atypical sleep was significantly more frequent in patients under mechanical ventilation than in those breathing spontaneously (p < 0.01). REM sleep was uncommon at any time of their ICU stay. Patients with complete disappearance of REM sleep (50% of patients) were more likely to have poor clinical outcomes than those with persistent REM sleep (24% vs. 9%, p = 0.03).ConclusionComplete disappearance of REM sleep was significantly associated with poor clinical outcomes in critically ill patients.

Situations and Risk Factors of Unplanned Extubation of Nasogastric Tubes in Inpatients: A Retrospective Study.

The aim of the study is to understand whether the risk factors of the unplanned extubation (UE) of nasogastric (NG) tubes vary among different inpatient situations. Inpatients who experienced UE between 2009 and 2022 at a medical center were selected, and electronic medical records were used to collect patient background data and their conditions during UE. A total of 302 patients were included in our analysis. Conscious patients were at greater risk of UE when coughing, scratching their nose, blowing their nose, or sneezing than those who were confused (odds ratio [OR] = 0.07, P < 0.001) and those who were drowsy or comatose (OR = 0.15, P = 0.026). During activity, repositioning, bathing, or changing incontinence pads, the risk of UE was higher in patients whose hands were not restrained at the time of UE than in those whose hands were restrained (OR = 0.05, P = 0.004), higher in those with companions than in those without companions (OR = 7.78, P = 0.002), and higher in those with longer NG tube placement time (OR = 1.05, P = 0.008). Accidental extubation (OR = 2.62, P = 0.007) occurred more frequently during activity, repositioning, bathing, or changing incontinence pads. There is an increased risk of UE in conscious patients during activity, repositioning, bathing, or changing incontinence pads. Patients inserted with an NG tube for a longer period of time were at greater risk of accidental extubation during activity, repositioning, bathing, or changing incontinence pads irrespective of whether a companion could aid them if their hands were or were not restrained.

Effect of the Levels and Sources of Noise on the Sleep Quality of Conscious Patients in Emergency Intensive Care Unit.

This study aimed to assess the levels and sources of noise in the emergency intensive care unit (EICU) of an emergency department and investigate their effects on the sleep quality of conscious patients. A study was conducted on patients admitted to the EICU from December 2020 to December 2023. They were categorised according to their sleep quality with the Pittsburgh Sleep Quality Index. Environmental noise levels were measured using precision sound level metres and environmental noise automatic monitoring instruments. Data analysis was performed using SPSS version 25.0, and Chi-square test, Fisher's exact probability and t-tests were conducted when applicable. The significance threshold was set at P < 0.05. Regression analysis was carried out for indicators with significant differences. A total of 200 patients were included in the study. Of them 96 in the ideal sleep group and 104 in the non-ideal sleep group. Patients with non-ideal sleep experienced significantly higher noise levels across various measures (P < 0.05). Additionally, patients with non-ideal sleep reported significantly higher occurrences of noise-related awakening, difficulty in falling asleep, nightmares or vivid dreams and sleepwalking episodes (P < 0.05). Significant differences in staff activities, including staff conversations, equipment noise exposure, cleaning activities, patient interventions and overhead pages, were observed between the groups (P < 0.05). Multivariate logistic regression analysis indicating that the average noise level, conversational speech, equipment alarms, ambient noise, peak noise levels, staff conversations, cleaning activities, patient interventions and overhead pages were significant contributors to poor sleep. The study suggested that high noise levels and staff-related activities affected the sleep quality of conscious patients in the EICU. Targeted measures could improve the prognoses of patients.

Comparative efficacy of non-pharmacological interventions for anxiety in adult intensive care unit patients: A systematic review and network meta-analysis.

The primary goal of the intensive care unit is to the anxiety of conscious patients is often ignored in the care unit. The purpose of this study was to assess the efficacy of various non-pharmacological therapies for anxiety disorders in adult patients in the intensive care unit, in order to enhance humanistic care in the intensive care unit and to promote the patients' physical and mental recovery together. We conducted a systematic and comprehensive search of the literature in five databases (including the Cochrane Library, PubMed, EBSCO, Web of Science, and Embase) covering nearly a decade for randomized controlled trials of non-pharmacological therapies to reduce anxiety in adult intensive care unit patients. Two researchers independently assessed the quality of the literature, collected and condensed the data, and used STATA software to perform a network meta-analysis. The ranking probabilities for each intervention were calculated using the Surface under the Cumulative Ranking (SUCRA) method. The study protocol was registered with PROSPERO. This study ultimately included 26 randomized controlled trials involving 2791 adult ICU patients. Non-pharmacological interventions for anxiety in adult ICU patients included music therapy, aromatherapy, ICU diary, virtual reality, massage therapy, monitoring room diary, and health education. when compared to the control group (usual care), aromatherapy + music therapy [MD = -2.65, 95% CI (-4.76, -0.54)] (P = 0.0137) and music therapy [MD = -1.77, 95% CI (-3.40, -0.13)] (P = 0.0338) were superior in reducing anxiety in adult ICU patients. The results of the network meta-analysis showed that aromatherapy combined with music therapy significantly alleviated anxiety in adult ICU patients (SUCRA: 99.8%). Music therapy combined with aromatherapy has demonstrated superior effectiveness compared to other non-pharmacological interventions for reducing anxiety in awake adults in the ICU. However, the underlying mechanisms of this combined therapy require further exploration. Future research on the use of music therapy combined with aromatherapy in the care unit may help reduce anxiety in patients while fostering their physical and mental healing; however, individual variances and unique clinical circumstances must be considered.

A 40-Year-Old Male Patient With Encephalopathy Hypertension And Emergency Hypertension With Sinus Tachycardia And Acute Kidney Injury. A Case Report.

We present the case of A male 40 years old with Encephalopathy Hypertension and Emergency Hypertension with Sinus Tachycardia and Acute Kidney Injury. the patient was diagnosed with hypertensive encephalopathy based on clinical criteria upon admission to the hospital, compared to the patient's condition when allowed to go home. Electrocardiography, chest x-ray, and laboratory examinations such as kidney function tests, liver function tests, and complete blood count were performed to identify other complications of hypertensive emergency. This patient was taken to the ER due to decreased consciousness after a seizure occurring shortly before being admitted. After a comprehensive physical examination, a blood pressure of 260/110 was recorded, and the patient exhibited decreased consciousness: GCS eye 4, verbal 3, motor 5. The patient was given intravenous anti-hypertensi to reduce blood pressure according to the recommended MAP, which is a 20-25% decrease in one hour. Subsequently, the patient's blood pressure normalized, and slowly, the patient's consciousness returned to normal. The patient was stable and, on the third day of treatment, was discharged with normal blood pressure and no neurological deficits.

Pain anticipation is a new behavioural sign of minimally conscious state.

Probing cognition and consciousness in the absence of functional communication remains an extremely challenging task. In this perspective, we imagined a basic clinical procedure to explore pain anticipation at bedside. In a series of 61 patients with a disorder of consciousness, we tested the existence of a nociceptive anticipation response by pairing a somaesthetic stimulation with a noxious stimulation. We then explored how nociceptive anticipation response correlated with (i) clinical status inferred from Coma Recovery Scale-Revised scoring, (ii) with an EEG signature of stimulus anticipation-the contingent negative variation-and (iii) how nociceptive anticipation response could predict consciousness outcome at 6 months. Proportion of nociceptive anticipation response differed significantly according to the state of consciousness: nociceptive anticipation response was present in 5 of 5 emerging from minimally conscious state patients (100%), in 10 of 11 minimally conscious state plus patients (91%), but only in 8 of 17 minimally conscious state minus patients (47%), and only in 1 of 24 vegetative state/unresponsive wakefulness syndrome patients (4%) (χ 2 P < 0.0001). Nociceptive anticipation response correlated with the presence of a contingent negative variation, suggesting that patients with nociceptive anticipation response were more prone to actively expect and anticipate auditory stimuli (Fisher's exact test P = 0.05). However, nociceptive anticipation response presence did not predict consciousness recovery. Nociceptive anticipation response appears as a new additional behavioural sign that can be used to differentiate minimally conscious state from vegetative state/unresponsive wakefulness syndrome patients. As most behavioural signs of minimally conscious state, the nociceptive anticipation response seems to reveal the existence of a cortically mediated state that does not necessarily reflect residual conscious processing.