Patients In Persistent Vegetative State Research Articles

A practical model-based segmentation approach for improved activation detection in single-subject functional magnetic resonance imaging studies.

Functional magnetic resonance imaging (fMRI) maps cerebral activation in response to stimuli but this activation is often difficult to detect, especially in low-signal contexts and single-subject studies. Accurate activation detection can be guided by the fact that very few voxels are, in reality, truly activated and that these voxels are spatially localized, but it is challenging to incorporate both these facts. We address these twin challenges to single-subject and low-signal fMRI by developing a computationally feasible and methodologically sound model-based approach, implemented in the R package MixfMRI, that bounds the a priori expected proportion of activated voxels while also incorporating spatial context. An added benefit of our methodology is the ability to distinguish voxels and regions having different intensities of activation. Our suggested approach is evaluated in realistic two- and three-dimensional simulation experiments as well as on multiple real-world datasets. Finally, the value of our suggested approach in low-signal and single-subject fMRI studies is illustrated on a sports imagination experiment that is often used to detect awareness and improve treatment in patients in persistent vegetative state (PVS). Our ability to reliably distinguish activation in this experiment potentially opens the door to the adoption of fMRI as a clinical tool for the improved treatment and therapy of PVS survivors and other patients.

Effects of high-frequency repetitive transcranial magnetic stimulation on the nutritional status of patients in a persistent vegetative state: A pilot study.

This paper presents a preliminary study on whether repetitive transcranial magnetic stimulation (rTMS) can modulate the nutritional status of persistent vegetative state (PVS) patients (the primary endpoint) by regulating the intestinal flora and the metabolites, with the correlation between them also investigated. Seventy-six patients with PVS were selected and divided into the observation group (n = 38) and the control group (n = 38) by random numerical grouping. All subjects' stool samples were examined for metabolites and analyzed regarding the short-chain fatty acids (SCFAs) content. All subjects' serum albumin, prealbumin, and hemoglobin levels were measured before and after the treatment. Nutrition risk screening 2002 was performed on all the subjects before and after the treatment and on the 30th and 90th days of the follow-up. (1) Intestinal flora structure: the Chao index, Ace index, and Shannon index of the observation group and the control group were significantly higher (p < 0.05), while the Simpson index was significantly lower (p < 0.05) following the treatment. (2) Metabolites of the intestinal flora: the observation group had significantly higher levels of acetic acid, butyric acid, and valeric acid (p < 0.05), as well as lower levels of propionic acid (p < 0.05) following the treatment. (3) Nutritional status (the primary endpoint): following the treatment, the above serum nutritional indices were significantly higher in both groups (p < 0.05), while the indices of the observation group were significantly higher than those of the control group (p < 0.05). The rTMS method may improve the nutritional status of patients with PVS by regulating the structure of the intestinal flora and affecting the level of SCFAs through the microbiota-gut-brain axis. The possible mechanism involves how high-frequency rTMS can cause increased excitation in the frontal lobe of the right side of the brain, thus regulating the 5-hydroxytryptamine and norepinephrine levels.

The experiences of the caregivers caring for the patients in persistent vegetative state due to traumatic brain injury.

Persistent vegetative state often occurs as a result of traumatic brain injuries; these patients are usually hospitalized for sustained periods, and the family caregivers are the main care providers in Iranian hospitals, especially for chronic and persistent vegetative state patients. The current study was conducted to investigate the family caregivers' experiences of caring for persistent vegetative state patients following traumatic brain injury. This descriptive phenomenological study was carried out in 2019. Semi-structured interviews were done with 12 family caregivers caring for the patients in persistent vegetative state, hospitalized in a trauma center, after taking informed written consent and assuring about anonymity and confidentiality of their personal information. The interviews were analyzed using the Colaizzis҆ method. After analysis of 12 interviews, 5 themes, and 10 subthemes were extracted from 428 codes. Five themes include "uncountable struggles/challenges," "looking for peace," "therapeutic concerns," "preserving the connection," and "unheard sounds." In this study, the family caregivers of the persistent vegetative state patients in the hospital experienced some challenges, and looked for peace by doing some work, for example, praying. They had some therapeutic concerns and unheard sounds and tried to fulfill them. We recommend, by using the results of this study and other related research, necessary care and facilities would be provided for the family caregivers of persistent vegetative state patients in hospitals.

Visa A. J. Kurki, A Theory of Legal Personhood

In recent times, ‘personhood questions’ come up frequently in a variety of bioethical contexts. For example, consider the classic debates such as the status of embryo and abortion, questions surrounding the status of patients in persistent vegetative state and end-of-life decision-making,1 or permissibility of the scientific experimentations on or eating of animals. Then there are the relatively newer personhood discussions around the responsibility for harms caused in Artificial Intelligence-based medical treatment, or the legal status of one’s genetic materials, or of the newly emergent entities such as organoids,2 synthetic embryos,3 and human–animal chimeras.4 While in the normative discussions, arguments based on ‘personhood’ sometimes argue for increasing legal protections, the conceptual aspects and what exactly the granting of legal personhood in these contexts entails often remain unclear. Visa AJ Kurki’s A Theory of Legal Personhood aims to ‘provide a theoretical framework for understanding legal personhood in contemporary Western legal systems’,5 to address these foundational questions. It largely succeeds in doing so. The many analytic nuances and thought-provoking claims in this work make it a rich playing field for bioethical minds to indulge.

MEDICAL ERROR, PERSISTENT VEGETATIVE STATE AND OVER NINETEEN LONG YEARS OF MEDICAL CARE

A medical error is a preventable adverse effect of medical care. Errors can happen in the hospital at the doctor’s office, at the pharmacy, laboratory and ward. These can also occur at home by the patient or the attendant. These errors may lead to death or major/minor injuries or can also be harmless. However these should be recorded, analysed and remedial measures implemented to reduce the risk of being committed in the future. We are reporting the medical care of our patient in persistent vegetative state over nineteen years due to medical error at our hospital resulting in brain anoxia. The key issues faced during the care were recurrent respiratory and urinary tract infections and in last one year kidney calculi leading to chronic kidney disease and its complications. There are no contractures or thrombo-embolic events and above all no bed sore over this period.

Impetuous suicidality with zolpidem use: a case report and minireview

Zolpidem is a clinically effective hypnotic medication for treating chronic insomnia. In the last decade, there has been increasing documentation of altered consciousness and behavioral changes following zolpidem administration. This report presents a case of a probable zolpidem induced suicide attempt and highlights similar studies of suicidal thoughts and behaviors of other patients that have taken the drug. We examine zolpidem and other treatments for insomnia, including the FDA approved hypnotics and frequently prescribed off-label medications, in terms of prescribing practices and adverse effects, especially altered consciousness and risk of suicide. Parallels are identified between the untoward activating side effects of zolpidem and its off-label use for patients in persistent vegetative states. We hypothesize that similar to the proposed mechanism in which the wakefulness promoted by zolpidem in vegetative patients is mediated by disruption of GABAergic tone in neurodormant brain regions, there may occur in patients with parasomnias interference of GABA activity in brain regions that maintain a high level of inhibitory regulation. Dosing recommendations are offered together with the FDA Safety Announcement addressing dose reductions for women due to possible carry-over effects the morning after ingesting zolpidem.

Outcomes of Bone Marrow-Derived Mononuclear Cell Transplantation for Patients in Persistent Vegetative State After Drowning: Report of Five Cases.

Aim: Anoxic brain injury (ABI) due to non-fatal drowning may cause persistent vegetative state (VS) that is currently incurable. The aim of this paper is to present the safety and feasibility of autologous bone marrow-derived mononuclear cell (BMMNC) transplantation in five drowning children surviving in persistent VS.Methods: We used BMMNC as a novel candidate therapeutic tool in a pilot phase-I study for five patients affected by neurological sequelae after near-death drowning. Autologous BMMNCs were freshly isolated using Ficoll gradient centrifugation then infused intrathecally to five patients. The number of transplantation varied from two to four times depending on the motor function improvement of patient after transplantation. Clinical therapeutic effects were evaluated using gross motor function measure and muscle spasticity rating scales, cognitive assessments, and brain MRI before and after cell administrations.Results: Six months after BMMNC transplantation, no serious complications or adverse events were reported. All five patients displayed improvement across the major parameters of gross motor function, cognition, and muscle spasticity. Three patients displayed improved communication including the expression of words. In particular, one patient remarkably reduced cerebral atrophy, with nearly normal cerebral parenchyma after BMMNC transplantation.Conclusions: Autologous BMMNC transplantation for the treatment of children in persistent VS after drowning is safe, feasible, and can potentially improve motor function and cognition and reduce muscle spasticity. These results pave the way for a future phase II clinical trial to evaluate the efficacy of the therapy.

Catatonia Rating Scales in Patients with Persistent Vegetative State

Objective: Persistent vegetative state (PVS) has similar clinical presentations with catatonia. Both PVS and catatonia can be evaluated using clinical observation and rating scales. We intended to study how catatonia rating scales perform in assessing PVS patients as compared to the standard PVS scale. Methods: Thirty residents from two nursing homes for PVS patients were evaluated with Coma Recovery Scale-Revised (CRS-R) and two catatonia rating scales (Bush–Francis Catatonia Rating Scale [BFCRS] and KANNER scale). Ten residents recovering from PVS were selected as controls, and twenty residents still meeting the criteria of PVS were selected as PVS group. Three evaluations were assessed over 6 months. We compared and analyzed the scores of each visit. The components of BFCRS and KANNER scales were also analyzed to create a simpler version for PVS patients. Results: BFCRS and KANNER scales, as well as their simplified versions, had significant correlations with CRS-R (p < 0.001 for all). This could imply that catatonia rating scales could also be used in evaluating PVS patients. Upon closer examinations of scale components, all the three scales shared components such as consciousness levels and eye movements, but BFCRS and KANNER have evaluations on rigidity and negativism, which CRS-R does not had. Conclusion: Our data suggest that PVS and catatonia share an underlying pathological mechanism. Evaluations of muscle tension, an important component of catatonia rating scales, might offer a more thorough assessment of PVS patients. Further study of using catatonia rating scales in PVS patients is warranted.

Information Seeking Experiences of Family Caregivers of Patients with Persistent Vegetative State: A Qualitative Study.

Background:Providing care for patients in Persistent Vegetative State (PVS) by family caregivers without enough training and knowledge may be problematic both for the patients and for the caregivers. Therefore, the present study tries to explain the experiences of family caregivers of patients with PVS of seeking information needed to provide adequate care.Materials and Methods:Twenty two participants, including 17 family caregivers and 5 professional caregivers were enrolled by purposive sampling into this qualitative content analysis study, carried out between 2013 and 2015. Unstructured interviews and field notes were used to gather the data. Data collection was stopped when data saturation was achieved. Data analysis was performed by content analysis based on Graneheim and Lundman's approach.Results:As a result of the analysis of the collected data a main theme emerged labeled as “Seeking constructive education” with three categories including “Neglected requisite education,” “Greedy search for useful education” and “Dynamic independence in care.”Conclusions:In this study, information seeking by family caregivers of patients with PVS was constructive. Family caregivers insistently sought needed information from various sources. Ultimately, they found these insistent efforts beneficial and fruitful, because their efforts made them independent in providing care for their patients.

Person-to-person transmission of microbes in a nursing home serving patients in a persistent vegetative state

Background: A probable outbreak of respiratory disease in a nursing home serving exclusively patients in a persistent vegetative state (PVS) resulted in hospitalization of eight patients. Methods: Microbes from all PVS patients’ respiratory tracks and environments were surveyed by microbiological methods. Major pathogenic microbes were analyzed by pulsed-field gel electrophoresis (PFGE). Results: 24 PVS patients were investigated. Half were colonized with at least four different pathogenic microbes in their respiratory tracts. The most prevalent microbes were Pseudomonas aeruginosa in 15 patients (62.5%), Serratia marcescens in 14 (58.3%), Citrobacter koseri in nine (37.5%), Streptococcus pneumoniae in six (25%), and Proteus mirabilis in five (20.8%). By PFGE analysis, one major pulsotype each was identified for S. marcescens (92.9%, 13/14) and S. pneumoniae (100%, 6/6), whereas diverse pulsotypes were identified for P. aeruginosa, C. koseri, and P. mirabilis. Both major pulsotypes for S. marcescens and S. pneumoniae were also found in strains from patients outside the nursing home. No environmental reservoir was found for prevalent microbes. Conclusions: Clonal transmission of S. marcescens and S. pneumoniae among PVS patients in the nursing home was evident, indicating a need to enforce control measures to reduce threats to this type of facility.

Erratum

Previous article FreeErratumPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreIn the article by Ellen Fox, Frona C. Daskal, and Carol Stocking, “Ethics Consultants’ Recommendations for Life-Prolonging Treatment of Patients in Persistent Vegetative State: A Follow-Up Study,” which appeared in The Journal of Clinical Ethics 18, no. 1 (Spring 2007): 64–71, in table 3, the numeric data for variations 2 and 3 were transposed. Previous article DetailsFiguresReferencesCited by Volume 30, Number 1Spring 2019 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/JCE2019301000 © 2019 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

Abstract TP544: Differences in Ascending Reticular Activating Systems Between Persistent Vegetative and Minimally Conscious States Following Putaminal Hemorrhage

Object: Investigated differences in ascending reticular activating systems(ARAS) of persistent vegetative state(PVS) and minimally conscious states(MCS) following putaminal hemorrhage(PH) Method: 17 patients with PH and classified them into PVS(7patients) and MCS(10patoents) groups. Eight parst of the ARAS were reconstructed: dorsal lower, ventral lower, whole upper, prefrontal cortex(PFC)-upper, premotor cortex-upper, primary motor cortex-upper, primary somatosensory cortex-upper, posterior parietal cortex-upper, ARAS. For each ARAS part, diffusion tensor tractography(DTT) paremeters(fractional anisotrophy(FA) and tract volume(TV)) were estimated. Result: The FA valvue did’t differ significantly among eight parts between the PVS and MCS groups ( p &gt; 0.05). The TV value of PFC-upper ARAS was significantly lower in PVS group. There were no other significant TV differences in other parts of the ARAS( p &lt; 0.05). Conclusion: The sole difference between PVS and MCS patients following PH was decrement in neural fibers in PFC-upper ARAS in PVS patients group. Based on result, it appears that the prefrontal portion of the upper ARAS is critical area when discerning PVS nad MCS in patients with PH. Key words: ascending reticular activating systems, prefrontal cortex, diffusion tensor tractography, putaminal hemorrhage

Still Human: A Thomistic Analysis of ‘Persistent Vegetative State’

Would Aquinas hold the view that a patient in a persistent vegetative state (PVS) is something other than a human being? Some recent interpreters have argued for this position. I contend that this reading is grounded in a false symmetry between the three stages of Aquinas’s embryology and the (alleged) three-stage process of death. Instead, I show that there are textual grounds for rejecting the view that the absence of higher brain activity in a patient would lead Aquinas to say that the patient no longer has a rational soul. On my reading of Aquinas, the patient in PVS has a rational soul and is unequivocally a human being.

Islamic perspective on end of life issues in persistent vegetative state patients - a case report

Persistent vegetative state (PVS) is a clinical condition of unawareness of self and environment with preserved sleep-wake cycles. Its clinical diagnosis can be a difficult unless a physician has adequate experience and expertise in evaluating neurological syndromes. Outcome is based on aetiology and age. Decisions on limiting life-sustaining treatment (LST) for these patients are emotionally and morally challenging. We present a case of a young boy who went into PVS following traumatic brain injury (TBI) with the aim to review some of the ethical issues regarding its management from Islamic perspective.

The effectiveness of non-invasive brain stimulation on arousal and alertness in patients in coma or persistent vegetative state after traumatic brain injury: Protocol of systematic review and network meta-analysis.

Traumatic brain injury is a leading cause of death and disability worldwide. The survivors usually suffer from disorders of consciousness, especially coma state and persistent vegetative state. For these patients, there is no standard treatment for them, but non-invasive brain stimulations are considered as relatively more acceptable treatments. However, the knowledge regarding the relative effectiveness and the rank of the effectiveness of the non-invasive brain stimulations is limited. Thus, in this study, we aim to conduct a systematic review and network meta-analysis to evaluate the effect of non-invasive train stimulations on arousal and alertness in patients in a coma or persistent vegetative state after traumatic brain injury. A comprehensive search strategy will be performed in the relevant databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Data). The random or quasi-random controlled trails focusing on the effectiveness of the non-invasive brain stimulations will be included. The risk of bias for the included studies will be appraised using the Cochrane collaboration tool for assessing risk of bias. The standard pairwise meta-analysis and a Bayesian network meta-analysis will be conducted. This research is a systematic review and network meta-analysis. Thus, there is no requirement of ethical approval and patient informed consent. CRD42018104945.

The influence of moxibustion on the bone metabolism of persistent vegetative state patients

Abjective To observe the influence of moxibustion on the bone metabolism of persistent vegetative state patients. Methods A total of 60 patients with persistent vegetative state were divided randomly into the treatment group and control group, 30 in each. Both groups were treated with routine therapy, and the patients used moxibustion on the acupoints of zhongwan, xiawan, qihai and guanyuan. The treatment lasted 12 weeks. The changes of T-lymphoctyte subgroups, serum immunoglobulin were tested and compared before and 12th week after treatment. Result After 12th week treatment, the BMD of distal radius (0.563 ± 0.205 g/cm2vs. 0.451 ± 0.114 g/cm2, t=2.615), the second lumbar vertebra (0.596 ± 0.108 g/cm2vs. 0.533 ± 0.127 g/cm2, t=2.069) and the femoral neck (0.567 ± 0.214g/cm2 to 0.463 ± 0.163g/cm2, t=2.117) in the treatment group were significantly higher than those in the control group (Ps<0.05). The PTH (6.41 ± 0.56 pmol/L vs. 6.72 ± 0.42 pmol/L, t=0.018), CT (217.48 ± 57.35 ng/L vs. 228.46 ± 52.44ng/L, t=0.012) and BGP (9.16 ± 1.57 g/L vs. 10.37 ± 2.37 g/L, t=0.023) in the treatment group were significantly higher than those in the control group (Ps<0.05). Conclusions Moxibustion can help to treat the bone metabolism of persistent vegetative state patients and prevent the osteoporosis. Key words: Moxa stick moxibustion; Persistent vegetative state; Bone mineral density; Bone density; Osteoporosis

Application of neurophysiology in electrical cervical spinal cord stimulation for persistent vegetative state

Objective To investigate the correlation between the overall scores of multimodal neurophysiological methods [electroencephalography (EEG), brainstem auditory evoked potential (BAEP), somatosensory evoked potential (SEP)] and therapeutic effect of cervical spinal cord stimulation (cSCS) in patients with persistent vegetative state (PVS) resulting from non-traumatic brain injury. Methods A retrospective analysis was conducted on the clinical data, neurophysiological scores and 1-year outcomes of 48 PVS patients who underwent treatment of cSCS (study group) at Department of Neurosurgery, Daqing Oilfield General Hospital from January 2010 to February 2017. The results were compared with the clinical data and outcomes of 50 patients undergoing conservative resuscitating treatment (control group) during the same period. We investigated the relationship between multimodal neurophysiological scores and therapeutic effect of cSCS treatment by Spearman rank correlation analysis in the study group. Results In the study group, 18 cases (37.5%) were resuscitated from PVS, 11 cases (22.9%) reported obvious therapeutic effect. In the control group, 3 cases (6.0%) were resuscitated from PVS, 4 cases (8.0%) had obvious therapetuic effect at 1 year post treatment. The treatment effect was significantly different between study group (R=0.6077) and control group (R=0.3966) by Ridit analysis (P<0.05). The cSCS treatment demonstrated better therapeutic effect than conservative resuscitating treatment. The Spearman rank correlation analysis showed that there was a positive correlation between the cSCS efficacy and neurophysiological scores (rs=0.854, P<0.05), i. e., higher overall neurophysiological scores indicated better therapeutic effect of cSCS. Conclusions (1) The cSCS awakening technology could promote neurological rehabilitation, improve the awakening ratio in PVS patients and facilitate early wake-up of PVS patients. (2) There is a positive correlation between multimodal neurophysiological scores and therapeutic effect of cSCS treatment. Multimodal neurophysiological scores play an important role in helping doctor choose cSCS awakening technology in clinical practice. Key words: Persistent vegetative state; Electrophysiology; Cervical spinal cord stimulation; Multimodal neurophysiology

Matters to address prior to introducing new life support technology in Japan: three serious ethical concerns related to the use of left ventricular assist devices as destination therapy and suggested policies to deal with them

BackgroundDestination therapy (DT) is the permanent implantation of a left ventricular assist device (LVAD) in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and the sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering.Main textWestern ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment.ConclusionThere is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation.

Dead-Survivors, the Living Dead, and Concepts of Death

The author introduces and critically analyzes two recent, curious findings and their accompanying explanations regarding how the folk intuits the capabilities of the dead and those in a persistent vegetative state (PVS). The dead are intuited to survive death, whereas PVS patients are intuited as more dead than the dead. Current explanations of these curious findings rely on how the folk is said to conceive of death and the dead: either as the annihilation of the person (via the secular conception of death), or that person’s continuation as a disembodied being (via folk dualism). The author argues that these two conceptions are incompatible and inconsistent with each other and the evidence. Contrariwise, the author argues that the folk intuition about dead-survivors and the living dead are more easily explained by appealing to cross-culturally established concepts: the folk biological concept of death the existential (metaphorical) concept of death, and the concept of social death.

Provision of renal care for patients with end stage kidney disease in persistent vegetative state, in United Arab Emirates: a national survey of renal physicians

ABSTRACTPatients with end stage kidney disease (ESKD) with severely impaired cognitive function have no survival benefit from dialysis. We therefore undertook a survey to explore the renal physicians’ practices of withholding and withdrawal of dialysis treatment in vegetative state patients in the United Arab Emirates (UAE). A cross sectional survey of 29 nephrology practices in UAE exploring physicians’ practices in making decisions of withholding and withdrawal of dialysis treatment during provision end-of-life care for patients in persistent vegetative state (PVS).The majority of participants practice in governmental non-for-profit dialysis units (79%), and think they are well prepared to make decision with patients and family on issues of dialysis withdrawal and withholding (69%). If a chronic dialysis patient became permanently unconscious only few respondents (17%) indicated probability of stopping dialysis. On the other hand, more respondents (48%) reported that dialysis is likely to be withheld in PVS patients who develop kidney failure. In high risk or poor prognosis ESKD patients and given how likely they would consider each option independently, respondents reported they are likely to consider time-limited dialysis in 78% of the time followed by stopping (46%) or forgoing (27%) dialysis. Majority of the participants perceived that their decisions in providing renal care for PVS patients in UAE were influenced by the family sociocultural beliefs (76% of participants), the current hospital policies (72% of participants), and by Islamic beliefs (66% of participants). Only few perceived access to palliative care (30%) and treatment cost (17%) to have an impact on their decision making.Decisions of initiation and continuation of dialysis treatment to ESKD patients in PVS are prevalent among nephrology practices in UAE. Development of local guidelines based on the societal values along with early integration of palliative kidney failure management care would be required to improve the quality of provision of end-of-life renal care in UAE.Abbreviations: ESKD: stage kidney disease; UAE: United Arab Emirates; PVS: persistent vegetative state; RPA: Renal Physicians Association; ASN: American Society of Nephrology; EMAN: Emirates Medical Association Nephrology Society; CPR: cardiopulmonary resuscitation.