scholarly journals Burying our mistakes: Dealing with prognostic uncertainty after severe brain injury

Bioethics ◽  
2020 ◽  
Vol 34 (6) ◽  
pp. 612-619
Author(s):  
Mackenzie Graham
Keyword(s):  
Brain Injury ◽  
Severe Brain Injury ◽  
Prognostic Uncertainty

Confronting the grey zone after severe brain injury

2019 ◽  
Vol 3 (6) ◽  
pp. 707-711 ◽  
Author(s):  
Andrew Peterson ◽  
Adrian M. Owen
Keyword(s):  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Clinical Care ◽  
Grey Zone ◽  
Severe Brain Injury ◽  
New Methods ◽  
Legal Decision Making ◽  
Technological Developments ◽  
The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

scholarly journals Simplified evaluation of CONsciousness disorders (SECONDs) in individuals with severe brain injury: A validation study

2021 ◽  
Vol 64 (5) ◽  
pp. 101432
Author(s):  
Charlène Aubinet ◽  
Helena Cassol ◽  
Olivier Bodart ◽  
Leandro R.D. Sanz ◽  
Sarah Wannez ◽  
...  
Keyword(s):  
Brain Injury ◽  
Validation Study ◽  
Severe Brain Injury ◽  
Consciousness Disorders

scholarly journals Inter-physician variability in strategies linked to treatment limitations after severe traumatic brain injury; proactivity or wait-and-see

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Annette Robertsen ◽  
Eirik Helseth ◽  
Reidun Førde
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Ethical Issues ◽  
Ethical Reasoning ◽  
Depth Information ◽  
Worst Case ◽  
Life Sustaining Treatment ◽  
Wait And See ◽  
Prognostic Uncertainty

Abstract Background Prognostic uncertainty is a challenge for physicians in the neuro intensive care field. Questions about whether continued life-sustaining treatment is in a patient’s best interests arise in different phases after a severe traumatic brain injury. In-depth information about how physicians deal with ethical issues in different contexts is lacking. The purpose of this study was to seek insight into clinicians’ strategies concerning unresolved prognostic uncertainty and their ethical reasoning on the issue of limitation of life-sustaining treatment in patients with minimal or no signs of neurological improvement after severe traumatic brain injury in the later trauma hospital phase. Methods Interviews with 18 physicians working in a neurointensive care unit in a large Norwegian trauma hospital, followed by a qualitative thematic analysis focused on physicians’ strategies related to treatment-limiting decision-making. Results A divide between proactive and wait-and-see strategies emerged. Notwithstanding the hospital’s strong team culture, inter-physician variability with regard to ethical reasoning and preferred strategies was exposed. All the physicians emphasized the importance of team—family interactions. Nevertheless, their strategies differed: (1) The proactive physicians were open to consider limitations of life-sustaining treatment when the prognosis was grim. They initiated ethical discussions, took leadership in clarification and deliberation processes regarding goals and options, saw themselves as guides for the families and believed in the necessity to prepare families for both best-case and worst-case scenarios. (2) The “wait-and-see” physicians preferred open-ended treatment (no limitations). Neurologically injured patients need time to uncover their true recovery potential, they argued. They often avoided talking to the family about dying or other worst-case scenarios during this phase. Conclusions Depending on the individual physician in charge, ethical issues may rest unresolved or not addressed in the later trauma hospital phase. Nevertheless, team collaboration serves to mitigate inter-physician variability. There are problems and pitfalls to be aware of related to both proactive and wait-and-see approaches. The timing of best-interest discussions and treatment-limiting decisions remain challenging after severe traumatic brain injury. Routines for timely and open discussions with families about the range of ethically reasonable options need to be strengthened.

Recovery curves for patients who have suffered very severe brain injury

1994 ◽  
Vol 8 (1) ◽  
pp. 54-69 ◽  
Author(s):  
Graham E Powell ◽  
Sarah L Wilson
Keyword(s):  
Brain Injury ◽  
Severe Brain Injury ◽  
Recovery Curves

The Brief Evaluation of Receptive Aphasia test for the detection of language impairment in patients with severe brain injury

Brain Injury ◽  
2021 ◽  
pp. 1-13
Author(s):  
Charlène Aubinet ◽  
Camille Chatelle ◽  
Sophie Gillet ◽  
Nicolas Lejeune ◽  
Margot Thunus ◽  
...  
Keyword(s):  
Brain Injury ◽  
Language Impairment ◽  
Severe Brain Injury ◽  
Receptive Aphasia

scholarly journals Swallowing disorders in severe brain injury in the arousal stage

2015 ◽  
Vol 58 ◽  
pp. e49-e50
Author(s):  
A. Bremare ◽  
A. Rapin ◽  
B. Veber ◽  
F. Beuret Blanquart ◽  
E. Verin
Keyword(s):  
Brain Injury ◽  
Swallowing Disorders ◽  
Severe Brain Injury

Complex Specialized Rehabilitation Following Severe Brain Injury

2007 ◽  
Vol 22 (4) ◽  
pp. 239-247 ◽  
Author(s):  
Kyaw Nyein ◽  
Aung Thu ◽  
Lynne Turner-Stokes
Keyword(s):  
Brain Injury ◽  
Severe Brain Injury

ECG Artifact and BIS in Severe Brain Injury

2005 ◽  
Vol 101 (5) ◽  
pp. 1566-1567 ◽  
Author(s):  
G D. Puri ◽  
D Nakra
Keyword(s):  
Brain Injury ◽  
Severe Brain Injury

Resolution of brain edema in severe brain injury at controlled high and low intracranial pressures

1984 ◽  
Vol 61 (4) ◽  
pp. 707-712 ◽  
Author(s):  
Meihong Cao ◽  
He Lisheng ◽  
Sun Shouzheng
Keyword(s):  
Cerebrospinal Fluid ◽  
Brain Injury ◽  
Brain Edema ◽  
External Ventricular Drainage ◽  
Blue Dye ◽  
Severe Brain Injury ◽  
Content Type ◽  
Intracranial Pressures ◽  
Low Levels ◽  
Cerebrospinal Fluid Protein

✓ A series of 87 patients with severe brain injury were studied. Intracranial pressure (ICP) monitoring and external ventricular drainage were used to control ICP at high and low levels. Clearance of ytterbium-169-labeled diethylenetriaminepentaacetic acid (169Yb-DTPA), Evans blue dye, and ventricular cerebrospinal fluid protein was measured at the two ICP levels over consecutive periods of 4 hours to confirm clearance of brain edema. The results support the hypothesis that brain edema is in part absorbed in the cerebrospinal fluid via transventricular flow.

Sign in / Sign up

Export Citation Format

Share Document