Caregiver burden after severe brain injury: The outcome we rarely measure

Hypoxic ischemic encephalopathy (HIE) is a severe brain injury that can lead to death and long-term disability. HIE can be treated with therapeutic hypothermia, and various adjuvant treatments (such as melatonin) are also utilized. Adjuvant therapies are not recommended outside clinical trials, and therapeutic hypothermia is not universally available. This study aimed to investigate the effects of Edaravone on improving levels of consciousness, hemodynamic stability, and short-term clinical outcomes of adult patients with severe HIE. To the best of our knowledge, this study is the first randomized clinical trial investigating the effects of Edaravone in adult patients with severe HIE. A double-blind clinical trial enrolled 72 severe HIE patients (aged > 18) within 24 h of onset who were diagnosed clinically and radiologically. Patients were randomized to Edaravone group (n = 20) and non-Edaravone group (n = 52). Measured parameters included level of consciousness, vital signs, Barthel index, and patient outcome (death or discharge). Statistical analysis was performed using SPSS version 27, with a significance level of P < 0.05. In short-term assessment of the patient's level of consciousness, the Edaravone group showed significant improvement in the Glasgow Coma Scale (GCS) post-intervention (p = 0.001). While the Edaravone group and non-Edaravone group showed no significant difference in outcome (p = 0.863) and Barthel score for discharged patients (P = 0.557). Vital signs showed significant differences between groups in temperature (P = 0.002). In the comparison of comorbidities between the Edaravone and non-Edaravone groups, only coronary artery bypass grafting was significantly different (P = 0.021). Edaravone improved the short-term level of consciousness in severe HIE adult patients, but there was no significant effect on outcome and level of independence in performing activities of daily living. Further investigation into Edaravone's effectiveness is warranted, particularly in patients with milder forms of HIE, as well as longer follow-up periods.

Congenital parvovirus B19 (PB19) infection can lead to severe fetal anemia and hydrops fetalis, necessitating in-utero transfusion (IUT) as a life-saving intervention. This study aimed to identify risk factors associated with unfavorable perinatal outcome following IUT in hydropic fetuses with PB19 infection, with the goal of optimizing transfusion strategies and improving fetal survival. A retrospective, multicenter, international cohort study was conducted across nine specialized fetal medicine centers in France, Belgium and the Czech Republic. This study included pregnant women with a fetus diagnosed with hydrops due to PB19 infection that underwent at least one IUT for severe fetal anemia between January 2014 and May 2024. Clinical, demographic and procedural data were analyzed. The primary outcome was to identify maternal, fetal, obstetric or IUT-related risk factors associated with adverse fetal or neonatal outcome, defined by a composite criterion of unfavorable outcome that included perinatal mortality and/or severe and persistent fetal anomalies, including severe fetal brain injury at follow-up. Statistical analysis was conducted using logistic regression models to assess potential risk factors. Of the 84 eligible cases, 78 pregnancies were included in the final analysis. The rate of perinatal survival without severe brain injury was 59.0% (46/78), while 41.0% (32/78) of cases had an unfavorable outcome, including 20 (25.6%) cases of stillbirth, nine (11.5%) cases of termination of pregnancy, one (1.3%) case of continuation of pregnancy despite severe prenatal neurological findings and two (2.6%) cases of neonatal death. Notably, a higher fetal hemoglobin (Hb) level (> 9.3 g/dL) after the first or second IUT was significantly associated with a reduced risk of unfavorable outcome (adjusted odds ratio (aOR), 0.6 (95% CI, 0.4-0.8)). A femur length Z-score of < -2 was associated with unfavorable outcome (aOR, 5.4 (95% CI, 1.3-27.0)). Transplacental vs transamniotic funicular puncture was not significantly associated with perinatal survival. IUT remains a cornerstone intervention for managing severe fetal anemia caused by PB19 infection; however, rates of perinatal loss continue to be substantial, especially in the presence of severe hydrops. Achieving higher post-transfusion Hb levels appears to be an important factor in improving survival outcomes for hydropic fetuses with PB19 infection. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.

Investigation of biochemical alterations in the brain of db/db diabetic mice using integrated FTIR and Raman spectroscopy combined with machine learning.

We report the case of a previously healthy woman in her 20s, pregnant, who developed acute liver failure (ALF) of unknown aetiology, complicated by a large right parietal intracerebral haemorrhage and signs of intracranial hypertension. She underwent emergency neurosurgical interventions, including craniotomy and decompressive craniectomy, with subsequent neurological stabilisation under intensive neuroprotective care. Following a multidisciplinary evaluation, she was considered eligible for liver transplantation and underwent orthotopic liver transplant with favourable clinical and neurological outcomes. This case illustrates that, in selected scenarios, the presence of acute neurological complications does not preclude successful liver transplantation. It emphasises the importance of individualised, multidisciplinary decision-making and highlights how early surgical management, ongoing neurocritical care and timely transplant coordination can result in meaningful recovery. The case also contributes to the limited literature on the intersection of ALF, severe brain injury and transplant eligibility.

Therapeutic hypothermia (TH) reduces mortality in neonatal hypoxic-ischemic encephalopathy (HIE), yet nearly half of treated infants suffer adverse outcomes. This study aimed to define the "Hypothermia Resistance" phenotype by characterizing the 4-day trajectories of multi-organ dysfunction and identifying the physiological signals associated with severe MRI injury. This retrospective cohort study included 24 term neonates with moderate-to-severe HIE treated with whole-body hypothermia. Patients were stratified into "Responder" (n = 18) and "Resistant" (n = 6) phenotypes based on systemic recovery patterns. Serial biomarkers (Lactate, Creatinine, AST, Platelets) were analyzed daily from Day 1 to Day 4. The primary outcome was brain injury severity on MRI assessed by the Weeke score. Admission characteristics and Day 1 biomarkers were comparable between groups. However, trajectories diverged significantly by Day 3 (72 h). The Resistant phenotype was characterized by a failure to clear systemic dysfunction, manifesting as persistent renal impairment (Median Creatinine: 1.39 vs 0.65 mg/dL; p < 0.01) and worsening thrombocytopenia (Median Platelets: 114 vs 190 × 10³/µL; p < 0.05) at 72 h. This "Day 3 Cliff" profile (Creatinine >1.0 mg/dL combined with Platelets <120 × 10³/µL) was strongly associated with severe MRI injury (diffusion restriction in basal ganglia/thalamus). Physiological recovery during cooling is a dynamic process. Persistent multi-organ dysfunction on Day 3 constitutes a "Hypothermia Resistance" profile that serves as a robust surrogate marker for ineffective neuroprotection, distinct from early severity markers.

In neonatal encephalopathy (NE), early biomarkers are needed to enhance prognostic accuracy. We hypothesized that blood lactate kinetics correlate with magnetic resonance imaging (MRI)-based brain injury severity. In this prospective cohort study, patients with NE admitted to a tertiary neonatal intensive care unit underwent brain MRI within the first week of life. Injury severity was graded using a validated MRI scoring system, with neonates categorized into low severity (LS) or high severity (HS) groups based on the 75th percentile of the total score. Lactate kinetics were evaluated through peak lactate levels, time to lactate normalization (TLN), and area under the curve (AUC). Associations between lactate kinetics and MRI scores were analyzed. Among forty‑eight neonates, 83% underwent therapeutic hypothermia. Compared with the LS group, the HS group had more seizures, higher Thompson and Sarnat scores, and more abnormal neurological exams at discharge. Peak lactate was higher in the HS group (p = 0.02) and correlated with MRI grey matter subscores (p = 0.004). Lactate AUC and TLN were positively associated with MRI total and grey matter scores (all p < 0.01). Lactate kinetics are associated with MRI-assessed brain injury severity in NE and may help stratification to tailor therapeutic strategies. Blood lactate kinetics are associated with MRI-assessed brain injury severity in neonates with neonatal encephalopathy (-NE-). This study highlights the value of serial lactate measures, beyond single time-point levels, in early prognostication. Combining biochemical markers with imaging scores may improve the identification of infants at high risk of adverse outcomes. These findings support the potential use of lactate kinetics to stratify patients and guide future therapeutic strategies.

Early developmental intervention seeks to enhance functional outcomes in preterm infants by leveraging neuroplasticity. We investigated the relationship between early intervention and neurodevelopmental outcomes in early childhood among preterm infants without severe brain injury. This prospective cohort study enrolled very-low-birth-weight infants (23+0-32+6 weeks' gestation) registered in the Korean Neonatal Network. Neurodevelopment was evaluated at corrected ages 18-24 months and chronological ages 33-45 months using the Bayley Scales of Infant and Toddler Development (Second or Third Edition), the Korean Developmental Screening Test, or both. Infants who began motor-based or language therapy prior to 18-24 months of corrected age were defined as the early intervention group. Of the 1797 infants who completed follow-up, 518 (28.8%) received early intervention. Compared to infants without early intervention, those with early intervention had lower gestational age and higher rates of prematurity-related complications and post-discharge rehospitalizations. The interaction between the intervention group and assessment time was statistically significant, indicating that early intervention was associated with a reduced risk of motor developmental delays over time (adjusted odds ratio 0.669, 95% confidence interval 0.472-0.949). Early intervention was associated with more favorable motor outcomes, highlighting the importance of timely support for high-risk preterm infants. Preterm infants with greater medical complexity more commonly received early intervention. Early intervention mitigated the progression of motor developmental delays over time. An enriched early environment may help offset the negative developmental impact of preterm complications.

Emerging evidence suggests that low-frequency neural oscillations are dynamically regulated by consciousness levels, with the recovery of low cortical activity potentially serving as a neurophysiological substrate for conscious emergence. Targeted enhancement of these low-frequency rhythms in patients with disorders of consciousness (DoC) may constitute a promising neuromodulation strategy to facilitate consciousness recovery in severe brain injury. This study systematically examined the neurophysiological effects of intermittent theta-burst stimulation (iTBS), specifically its potential to enhance low-frequency cortical activity and promote consciousness recovery in patients with DoC. Through multimodal neural assessments, we aimed to elucidate the mechanistic relationship between iTBS-induced neural oscillation modulation and behavioral manifestations of consciousness improvement. This prospective cohort study enrolled 30 patients with DoC, of whom 18 completed the full intervention protocol. Two-way repeated-measures analysis of variance revealed significant group × time interaction effects on the Coma Recovery Scale-Revised (CRS-R) scores, F(1, 16) = 6.543, p = 0.021. Post hoc simple effects analysis demonstrated significant temporal improvement in the active transcranial magnetic stimulation (TMS) group, F(1, 16) = 36.463, p < 0.001, with mean CRS-R scores increased from 9.300 ± 1.320 at baseline to 11.700 ± 1.409 post-intervention (p < 0.001). Conversely, sham stimulation revealed statistically nonsignificant changes (9.845 ± 1.476 versus 10.750 ± 1.575, p = 0.067). Neurophysiological assessments revealed emerging neurophysiological changes in the iTBS group, including enhanced resting-state low-frequency oscillations (delta: 21.642% increase, p = 0.449; theta: 6.800% increase, p = 0.789) and augmented auditory-evoked responses (phrase-level 22.917% increase, p = 0.280; syllable-level: 22.963% increase, p = 0.504), suggesting potential neural plasticity mechanisms that require further validation. Collectively, this study established iTBS targeting the left dorsolateral prefrontal cortex as a clinically effective and well-tolerated neuromodulation approach for consciousness rehabilitation in patients with DoC, with therapeutic effects mediated by iTBS-induced enhancement of thalamocortical low-frequency oscillations. https://www. gov. Unique identifier: NCT03385278. Registered on October 24, 2017.

The current study investigated the extent to which epilepsy comorbidity phenotypes (relatively healthy, posttraumatic stress disorder, polytrauma, bipolar/substance use disorder, chronic disease, and anxiety and depression) are associated with pain interference, sleep interference, and dissociative symptoms for post-9/11 Veterans with epilepsy (VWE). A total of 482 veterans were recruited via postal mail with a final sample size of 423 veterans included for analysis, with 59 veterans removed due to incomplete data. Veterans were largely non-Hispanic White (85.80%) and predominantly female (54.80%). Three series of hierarchical blockwise regressions were conducted to test the predictive capability of the epilepsy phenotypes for pain interference, sleep interference, and dissociative symptoms while controlling for covariates (age, ethnicity, sex, traumatic brain injury severity, epilepsy interference, caregiver status, blast exposure, and warzone deployment). After adjusting for covariates, the posttraumatic stress disorder, polytrauma, and chronic disease phenotypes remained significant predictors of pain interference, and the polytrauma and bipolar/substance use disorder phenotypes remained significant predictors of sleep interference. No phenotype predicted dissociative symptoms in fully adjusted models. Critically, epilepsy interference was the single most consistent and strongest predictor across models (p < .001), accounting for the largest unique share of variance in pain, sleep, and dissociative symptom scores. Among VWE, some epilepsy phenotypes may account for independent risk beyond demographic and injury characteristics for pain and sleep interference. These findings underscore the importance of targeted assessment and intervention strategies tailored to specific comorbidity profiles in the management of pain and sleep difficulties among VWE. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objectives Chronic disorders of consciousness (DOC) represent a profound clinical challenge with few effective therapeutic options. Transcranial focused ultrasound (tFUS) is an emerging non-invasive neuromodulation technique capable of targeting deep brain structures implicated in consciousness, such as the thalamus. In this work, we present a longitudinal, multi-modal investigation into the clinical and neural outcomes following thalamic tFUS in a patient with chronic DOC. Methods A patient in a chronic minimally conscious state underwent a course of tFUS treatment targeting the right central thalamus. The intervention was applied for 20 minutes, three times per week, over a period of four weeks (12 sessions in total). We conducted comprehensive longitudinal assessments using clinical scales (Coma Recovery Scale-Revised and Glasgow Coma Scale). Besides, resting-state functional near-infrared spectroscopy (fNIRS) to measure cortical functional connectivity, and electroencephalogram (EEG) to analyze neurophysiological dynamics. Results The patient demonstrated a progressive and clinically significant behavioral recovery, ultimately emerging from the minimally conscious state. This recovery was accompanied by observable neural reorganization. fNIRS revealed a systematic enhancement of functional connectivity, especially within the prefrontal cortex and between prefrontal-sensorimotor networks. Concurrently, EEG analysis showed a marked, progressive suppression of pathological slow-wave (Delta and Theta) power in frontal regions. The intervention was well-tolerated with no adverse events or structural brain changes observed. Conclusions This case provides cohesive, multi-modal evidence suggesting that targeted thalamic tFUS may be associated with a restorative process, concurrent with the normalization of dysfunctional cortical rhythms and the reintegration of large-scale brain networks that parallel the recovery of consciousness. Our findings offer preliminary insights supporting the continued investigation of tFUS as a potential therapeutic strategy for patients with severe brain injury.

Subarachnoid hemorrhage (SAH) is a devastating stroke subtype with high mortality and morbidity, causing severe brain injury through neuroinflammation and oxidative stress. Alisol A, a bioactive compound derived from Alisma orientale, has demonstrated anti-inflammatory, antioxidant, and metabolic-regulating properties. However, the potential role of alisol A in SAH has not yet been explored. This study was conducted to investigate the therapeutic role of alisol A in brain injury induced by SAH, with a particular focus on its underlying metabolic mechanisms. Our results showed that alisol A mitigated neuroinflammation and oxidative stress and alleviated brain injury and neurological deficits in SAH mice. This neuroprotective effect was associated with modulation of mitochondrial metabolism, notably a reduction in succinate accumulation, an important metabolite associated with inflammation and oxidative damage. Supplementation with succinate partially counteracted the observed anti-inflammatory and antioxidant effects of alisol A. Crucially, we identified sirtuin 3 (SIRT3) as an important mediator of these processes. The beneficial effects of alisol A on mitochondrial metabolism, as well as its anti-inflammatory and antioxidant actions, were dependent on SIRT3 upregulation. Overall, our study demonstrated that alisol A could protect against SAH-induced brain injury by upregulating SIRT3 expression, which reprogrammed mitochondrial metabolism and prevented succinate accumulation, thereby reducing neuroinflammation and oxidative stress. These findings deepen our understanding of the metabolic regulatory role of alisol A and highlight its therapeutic potential for SAH and other neurological disorders characterized by neuroinflammation and oxidative stress.

A pregnant woman at 32 weeks' pregnancy presented to the Emergency Department with cardiopulmonary arrest requiring active cardiopulmonary resuscitation and perimortem caesarean section. Operative findings revealed a fresh stillborn foetus and a completely detached placenta with 4 L of retroplacental blood and blood clots, suggesting a severe case of placental abruption. An inadvertent posterior uterine wall incision was detected upon uterine closure. A formal exploratory laparotomy was performed after the patient was well-stabilised following the return of spontaneous circulation. The inadvertent posterior uterine wall incision indicated a 135° uterine torsion. The mother survived but suffered severe brain injury.

Contrast-enhanced ultrasound (CEUS) has great potential for assessing increased intracranial pressure (ICP); however, the most appropriate parameters remain unknown. This study aimed to explore the application of quantitative analysis of CEUS diagnosing increased ICP in patients with severe brain injury after surgery, and to provide a novel idea for the non-invasive evaluation of ICP. This observational study included 34 patients with craniocerebral injuries admitted to the intensive care unit from May 2022 to December 2023. Patients were divided into a normal cranial pressure group (< 20mm Hg) and an intracranial hypertension group (≥ 20mm Hg) on the basis of the invasive ICP monitoring values. All patients underwent CEUS examination within 24h postoperatively. Time-intensity curves of the central retinal artery and short posterior ciliary artery were generated using CEUS quantitative analysis software. Quantitative parameters were obtained, and the difference was calculated. The diagnostic accuracy of each parameter was assessed by computing the area under the receiver operating characteristic curve (AUC). In total, 15 patients (44%) had intracranial hypertension. The arrival time difference (ΔAT) and peak time difference (ΔTP) were significantly higher in the intracranial hypertension group than in the normal cranial pressure group (P < 0.001 and P = 0.010, respectively). The peak intensity difference (ΔPkI) was significantly lower in the intracranial hypertension group than in the normal cranial pressure group (P = 0.025). The diagnostic accuracy of ΔAT for identifying intracranial hypertension was excellent, with an AUC of 0.944 [95% confidence interval (CI) 0.874-1.014], which yielded an optimal cutoff value of 0.86s with 93.3% sensitivity (95% CI 0.849-1.017) and 84.2% specificity (95% CI 0.719-0.964). The AUC of ΔAT was significantly higher than that of ΔTP and ΔPkI (AUC 0.761 and 0.721, respectively; both P < 0.05). The CEUS quantitative analysis parameter, ΔAT, is a promising parameter for evaluating postoperative ICP elevation in patients with severe brain injury.

Meconium serves as a valuable biological matrix for characterizing fetal metabolic signatures throughout gestation. Selective fetal growth restriction (sFGR) is associated with adverse neurological outcomes, potentially mediated by underlying metabolic perturbations. However, the specific relationship between dysregulated meconium metabolome and brain injury in sFGR remains poorly understood. Untargeted metabolomics analysis was performed on meconium samples from sFGR (n = 20) and monochorionic diamniotic twins with birth weight concordance (MCDA-C, n = 13) to quantify metabolic alterations. Neonatal brain injury was assessed via cranial ultrasonography, and long-term neurodevelopmental outcomes were evaluated at 2-3 years of age using the Ages and Stages Questionnaire-third edition subscale. Univariate analysis, partial least-squares discrimination analysis (PLSDA) and pathway analysis were employed to compare the metabolic profiles across different brain injury categories. Machine learning algorithms and receiver operating characteristic (ROC) curve were utilized to identify potential biomarkers associated with neonatal brain injury. Spearman's-based correlation analysis was employed to correlate metabolites levels with physical development and long-term neurodevelopmental outcomes. In our study, PLSDA revealed distinct clustering of meconium metabolites profiles in neonates with severe brain injury compared to those with mild brain injury or normal findings. In all sFGR neonates, logistic regression identified two fatty acid metabolism products, 13, 16-docosadienoic acid and nonadecanoic acid, as notably associated with neonatal severe brain injury. Divergent meconium metabolic signatures associated with severe brain injury were observed between the smaller fetus (sFGR-S) and larger fetus (sFGR-L) in sFGR twins. In particular, nicotinamide, hippuric acid, citramalic acid and succinic acid were closely associated with severe brain injury in sFGR-S. Pathway analysis implicated significant dysregulation of the citrate cycle in this subgroup. For sFGR-L, histidine and trans-4-hydroxyproline emerged as best predictive markers for severe brain injury and showed significant correlations with long-term neurodevelopmental outcomes including gross motor and fine motor. Dysregulated fatty acid metabolites in the meconium of sFGR neonates are associated with severe brain injury. Divergent metabolomic profiles between sFGR-S and sFGR-L revealed distinct pathological mechanisms underlying brain injury. These findings provide novel insights into metabolic mechanisms of brain injury in sFGR and offer potential predictive biomarkers for adverse neurological outcomes.

Background/Objectives: Post-cardiac arrest syndrome (PCAS) induces systemic ischemia-reperfusion injury accompanied by sepsis-like coagulopathy. This coagulopathy presents heterogeneously, yet distinct coagulation phenotypes and their impact on hypoxic-ischemic brain injury (HIBI) remain poorly defined. We aimed to identify coagulation phenotypes using latent class analysis (LCA) and assess their association with 6-month neurological outcomes. Methods: We retrospectively analyzed adult out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM) between 2011 and 2019 from a prospective registry at a tertiary academic center. LCA was performed using coagulation biomarkers measured at admission and 24 h post-return of spontaneous circulation: D-dimer, fibrinogen, antithrombin III (ATIII), platelet count, and PT-INR. The primary outcome was poor neurological outcome (Cerebral Performance Category 3-5) at 6 months. Secondary outcomes included in-hospital mortality and cerebral edema severity assessed by gray-to-white matter ratio (GWR) on brain CT. Results: Among 325 patients, LCA identified three phenotypes: Class 1 (Preserved Coagulation, 36.9%), Class 2 (Hypercoagulable State, 41.5%) characterized by elevated D-dimer with preserved fibrinogen and ATIII, and Class 3 (Consumptive Coagulopathy, 21.5%) marked by profound D-dimer elevation with fibrinogen <150 mg/dL and ATIII <60%. Class 3 exhibited the lowest GWR and highest neuron-specific enolase levels. In multivariable analysis adjusting for age, low-flow time, initial rhythm, and lactate, Class 3 independently predicted poor neurological outcome (adjusted OR 4.52; 95% CI 2.15-9.48), whereas Class 2 did not. Conclusions: PCAS-related coagulopathy is heterogeneous. A consumptive coagulopathy phenotype identifies a high-risk subgroup associated with severe brain injury and poor long-term neurological outcomes. Early identification of this phenotype may enable targeted prognostication and guide future phenotype-specific interventional strategies.

Paroxysmal sympathetic hyperactivity (PSH) is characterized by excessive autonomic activation typically seen after severe brain injury. PSH has not previously been reported in association with cardiogenic shock. Here, we report a case of PSH during the treatment of cardiogenic shock with dilated cardiomyopathy. A 60-year-old man with cardiogenic shock and dilated cardiomyopathy was transferred to our hospital. He was intubated and received an Impella support. On Day 4 post-admission, paroxysmal fever, tachycardia, tachypnea, and abnormal muscle tone were observed in the extremities. Antiepileptic drugs and broad-spectrum antibiotics were ineffective, and the seizure pattern suggested PSH; therefore, gabapentin was started on Day 27 post-admission. The seizures gradually resolved and eventually resolved. This case suggests that PSH may be triggered by functional disturbances in cerebral perfusion and autonomic regulation associated with cardiogenic shock, even in the absence of irreversible brain injury. When patients with cardiogenic shock present with paroxysmal tachycardia, tachypnea, and fever, PSH should be considered in the differential diagnosis. Early recognition of PSH may facilitate timely treatment and contribute to improved clinical outcomes.

Quantitative interpretation using ADC values for subjective MRI classification of neonatal hypoxic-ischemic encephalopathy.

Background: Patients with severe brain injury often experience impaired airway clearance due to decreased consciousness, increasing the risk of secretion accumulation and respiratory complications. Suction and chest physiotherapy are essential interventions to maintain airway patency. Aim: This study aimed to evaluate the effectiveness of suction and chest physiotherapy in managing ineffective airway clearance in patients with severe brain injury. Method: This study employed a case study design with a nursing care approach. Two male patients with a medical diagnosis of severe brain injury were selected using purposive sampling. Data were collected through direct observation, physical examination using the IPPA approach, and medical record review. Interventions included suction for 2–3 minutes (each suction lasting 10–15 seconds) and chest physiotherapy for 5 minutes, conducted over three consecutive days. Data were analyzed descriptively by comparing conditions before and after interventions, and results were interpreted in the context of nursing theory and previous research. Results: The application of suction and chest physiotherapy maintained airway patency, kept oxygen saturation within normal limits, and effectively controlled secretion accumulation. Although some secretions remained, the interventions prevented respiratory complications and supported patient respiratory function. Conclusion: Suction and chest physiotherapy are effective in managing airway clearance in patients with severe brain injury. Continuous nursing interventions are required due to patients’ limited ability to clear their airways independently. These findings highlight the crucial role of nursing care in maintaining airway patency and supporting the neurological prognosis of patients.

Bedside Evaluation of Swallowing in Severe Brain Injury Patients in Subacute Setting