scholarly journals Persistent vegetative state: an overview

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Gabriel Alexander Quiñones-Ossa ◽  
Yeider A. Durango-Espinosa ◽  
Tariq Janjua ◽  
Luis Rafael Moscote-Salazar ◽  
Amit Agrawal
Keyword(s):  
Intensive Care ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Clinical History ◽  
Main Body ◽  
Disorder Of Consciousness ◽  
Family Perspective ◽  
Patient Status ◽  
History Of ◽  
State Diagnosis

Abstract Background Disorder of consciousness diagnosis, especially when is classified as persistent vegetative state (without misestimating the other diagnosis classifications), in the intensive care is an important diagnosis to evaluate and treat. Persistent vegetative state diagnosis is a challenge in the daily clinical practice because the diagnosis is made mainly based upon the clinical history and the patient behavior observation. There are some specific criteria for this diagnosis, and this could be very tricky when the physician is not well trained. Main body We made a literature review regarding the persistent vegetative state diagnosis, clinical features, management, prognosis, and daily medical practice challenges while considering the bioethical issues and the family perspective about the patient status. The objective of this overview is to provide updated information regarding this clinical state’s features while considering the current medical literature available. Conclusions Regardless of the currently available guidelines and literature, there is still a lot of what we do not know about the persistent vegetative state. There is a lack of evidence regarding the optimal diagnosis and even more, about how to expect a natural history of this disorder of consciousness. It is important to recall that the patients (despite of their altered mental state diagnosis) should always be treated to avoid some of the intensive care unit long-stance complications.

scholarly journals Persistent vegetative state after traumatic brain injury - a case report and review of the literature

2014 ◽  
Vol 13 (3) ◽  
pp. 358-365 ◽  
Author(s):  
Mohammad Yousuf Rathor ◽  
Mohammad Fauzi Abdul Rani ◽  
TCA Shahrin ◽  
HZ Hashim
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Vegetative State ◽  
Medical Science ◽  
Persistent Vegetative State ◽  
Disorder Of Consciousness ◽  
End Of Life Decisions ◽  
The Past ◽  
Late Recovery ◽  
Behavioural Evidence

Persistent vegetative state (PVS) is a chronic neurological disorder of consciousness, in which patients appear to be awake, but show no behavioural evidence of awareness. It cannot be diagnosed with certainty and misdiagnosis is very frequent. Its management has become one of the most controversial and emotive issues in medical ethics and medical law over the past few decades. The results of recent neuroimaging studies along with well-documented reports of significant late recovery of some PVS patients have challenged the long-held view that restoration of function in the severely traumatic brain injury (TBI) patients is not possible. Some clinicians believe that PVS is a misused term with the potential consequences of withdrawal and withholding of care, and tendency towards less aggressive management. Further naming these patients as “vegetative” has been misinterpreted by many groups that the patient is no more a human but “vegetable” like.  Recently there has been an attempt to replace PVS by new, more appropriate name "Unresponsive Wakefulness Syndrome" (UWS). As opposed to brain death, PVS is not recognized by statute as death in any legal system.  The context within which end of life decisions are being made for these patients has led to outrage especially if decisions were made to terminate hydration and nutrition. We present a case of young boy who is in a PVS following TBI with the aim to review some of the contemporary issues regarding their management. DOI: http://dx.doi.org/10.3329/bjms.v13i3.19159 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.358-365

scholarly journals DEVELOPMENT OF NEUROCRITICAL CARE

2012 ◽  
Vol 67 (9) ◽  
pp. 27-30 ◽  
Author(s):  
M. A. Piradov ◽  
V. V. Moroz
Keyword(s):  
Mechanical Ventilation ◽  
Neurocritical Care ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Multiple Organ ◽  
Walking Ability ◽  
Severe Stroke ◽  
History Of ◽  
Further Development ◽  
Goals And Objectives

In this review we provide the definition, goals and objectives of neurocritical care, evaluation of brief history of its development. Mechanical ventilation, intracranial hypertension, neuromonitoring as underlying basics of neurocritical care approaches are discussed. The main types of pathology and specific methods used in neurocritical care units are discussed. The results of our own research on brain death — the development of national criteria; for Guillain-Barre syndrome — a double decrease in the length of mechanical ventilation and in 2.5 times of the recovery time for independent walking ability; on diphteric polyneuropathy — reduced by 11 times mortality compared with nation-wide indicators of non-traumatic persistent vegetative state — the development of diagnostic and predictive neurophysiologic criteria are demonstrated. Research data of multiple organ disfunction syndrome in severe stroke are described. Further development of neurocritical care is being discussed.

Ethics Consultation: Persistent Brain Death and Religion: Must a Person Believe in Death to Die?

1995 ◽  
Vol 23 (3) ◽  
pp. 291-294 ◽  
Author(s):  
Jeffrey Spike ◽  
Jane Greenlaw
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Nursing Staff ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Ethics Consultation ◽  
Medical Professionals ◽  
Rehabilitation Facility ◽  
Brain Dead ◽  
Attending Physician

We first heard about this case from nurses in one of our intensive care units (ICUs) while we were conducting an inservice. When the session was over, we discussed it between ourselves, and decided that it must have been misrepresented. The case had been presented as one of a teenager who was brain dead, had been so for six months, yet had been brought into the ICU for treatment. We have run into this before, we thought: medical professionals confusing brain death with persistent vegetative state (PVS). But, of course, we reasoned, no one can be brain dead for six months. To us, as it would to many, the case sounded like a clinical and ethical impossibility. A week later, we were called by an attending physician from another ICU, at the urging of that unit's nursing staff. They had a patient who was brain dead, whose presence was causing distress among the staff. Ronald Chamberlain, a fifteen-year-old boy, had been a patient at a nearby longterm rehabilitation facility that is equipped to care for ventilator-dependent patients.

scholarly journals Characteristics and Outcomes of Children with Clinical History of Atopic Versus Non-atopic Asthma Admitted to a Tertiary Pediatric Intensive Care Unit

2018 ◽  
Vol 12 (1) ◽  
pp. 21-28
Author(s):  
Jamie Causey ◽  
Traci Gonzales ◽  
Aravind Yadav ◽  
Syed Hashmi ◽  
Wilfredo De Jesus-Rojas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Status Asthmaticus ◽  
Cardiopulmonary Arrest ◽  
Pediatric Intensive Care ◽  
Clinical History ◽  
Atopic Asthma ◽  
History Of ◽  
Median Hospital

Background: Children admitted to the Pediatric Intensive Care Unit (PICU) with status asthmaticus have variable clinical courses, and predicting their outcomes is challenging. Identifying characteristics in these patients that may require more intense intervention is important for clinical decision-making. Objective: This study sought to determine the characteristics and outcomes, specifically length of stay and mortality, of atopic versus non-atopic asthmatics admitted to a PICU with status asthmaticus. Methods: A retrospective study was conducted at a children’s hospital from November 1, 2008 to October 31, 2013. A total of 90 children admitted to the PICU were included in the analysis. Patients were divided into two groups based on the presence of specific historical data indicative of a clinical history of atopy. Children were considered to be atopic if they had a parental history of asthma, a personal history of eczema, or a combined history of wheezing (apart from colds) and allergic rhinitis (diagnosed by a medical provider). The median hospital Length Of Stay (LOS), PICU LOS, cardiopulmonary arrest, and mortality were compared between atopic and non-atopic asthma groups. Regression models were used to estimate the LOS stratified by atopic or non-atopic and by history of intubation in present hospitalization. Results: Median hospital LOS for atopic children was 5.9 days (IQR of 3.8-8.7) and 3.5 days (IQR of 2.2-5.5) for non-atopic asthmatics (z = 2.9, p = 0.0042). The median PICU LOS was 2.5 days (IQR 1.4-6.1) for atopic asthmatics and 1.6 days (IQR 1.1-2.4) for non-atopic asthmatics (z = 2.5, p = 0.0141). The median LOS was significantly higher for atopic intubated patients compared to non-atopic intubated patients (p=0.021). Although there was an increased tendency towards intubation in the atopic group, the difference was not significant. There was no significant difference in cardiopulmonary arrest or mortality. Conclusion: A clinical history of atopic asthma in children admitted to the PICU with status asthmaticus was associated with longer length of stays The longest LOS was observed when atopic patients required intubation.

Plum and Posner's Diagnosis and Treatment of Stupor and Coma

2019 ◽  
Author(s):  
Jerome B. Posner ◽  
Clifford B. Saper ◽  
Nicholas D. Schiff ◽  
Jan Claassen
Keyword(s):  
Brain Death ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Diagnosis And Treatment ◽  
Comprehensive Treatment ◽  
Disorder Of Consciousness ◽  
Disease States ◽  
Minimally Conscious

This text is an update of a classic work on diagnosing the cause of coma, with the addition of new sections on the treatment of comatose patients. The first chapter provides an up-to-date review on the brain mechanisms that maintain a conscious state in humans and how lesions that damage these mechanisms cause loss of consciousness or coma. The second chapter reviews the neurological examination of the comatose patient, which provides the basis for determining whether the patient is suffering from a structural brain injury causing the coma or from a metabolic disorder of consciousness. The third and fourth chapters review the pathophysiology of structural lesions causing coma and the specific disease states that result in coma. Chapter 5 is a comprehensive treatment of the many causes of metabolic coma. Chapter 6 review psychiatric causes of unresponsiveness and how to identify and treat them. Chapters 7 and 8 review the overall emergency treatment of comatose patients, followed by the treatment of specific causes of coma. Chapter 9 examines the long-term outcomes of coma, including the minimally conscious state and the persistent vegetative state, how they can be distinguished, and their implications for eventual useful recovery. Chapter 10 reviews the topic of brain death, the standards for examination of a patient that are required to make the determination of brain death, and the ethics of diagnosis and treatment of patients who, by definition, have no way to approve of or communicate about their wishes.

scholarly journals The altered state of consciousness: clinical assessment and monitoring

2011 ◽  
Author(s):  
Maria Grazia Inzaghi ◽  
Matteo Sozzi
Keyword(s):  
Task Force ◽  
Work Group ◽  
Single Case ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Consensus Conference ◽  
Future Research ◽  
Disorder Of Consciousness

Aim of this work is to provide an overview on the main clinical issues concerning disorder of consciousness (DOC). After a briefly description of the debate on clinical differences in states of altered consciousness, we report the description of clinical features of the three different levels of DOC: coma, vegetative state, and minimally conscious state, according to the Multi Society Task Force for Persistent Vegetative State (1994) and the Aspen Work Group (Giacino et al., 2002). We will then describe an observation procedure, stated by Whyte and coworkers in 1999, based upon a single-case methodology aimed to assess responsiveness and its variations. At least, we will give a description of the evidences on stimulation treatment efficacy, as we collected in occasion of the last Consensus Conference in Neuropsychological Rehabilitation held in Siena (Italy) in 2010. Our conclusions confirm the lack of evidences concerning the efficacy of treatment for recovery of consciousness in agreement with other authors and we will finally provide suggestions for future research.

Persistent vegetative state in head injury

2005 ◽  
Vol 2 (2) ◽  
pp. 81-85
Author(s):  
Deepak Kumar Gupta ◽  
AK Mahapatra
Keyword(s):  
Head Injury ◽  
Vegetative State ◽  
Persistent Vegetative State

Component resolved diagnostics in peanut sensitized children with and without a history of clinical reaction

2020 ◽  
Vol 41 (5) ◽  
pp. 336-340
Author(s):  
Yasmin Hamzavi Abedi ◽  
Cristina P. Sison ◽  
Punita Ponda
Keyword(s):  
Retrospective Chart Review ◽  
Clinical History ◽  
Specific Ige ◽  
Exact Test ◽  
Ara H 1 ◽  
Sige Level ◽  
History Of ◽  
Laboratory Procedures ◽  
Ige Mediated ◽  
The Relationship

Background: Serum Peanut-specific-IgE (PN-sIgE) and peanut-component-resolved-diagnostics (CRD) are often ordered simultaneously in the evaluation for peanut allergy. Results often guide the plans for peanut oral challenge. However, the clinical utility of CRD at different total PN-sIgE levels is unclear. A commonly used predefined CRD Ara h2 cutoff value in the literature predicting probability of peanut challenge outcomes is 0.35kUA/L. Objective: To examine the utility of CRD in patients with and without a history of clinical reactivity to peanut (PN). Methods: This was a retrospective chart review of 196 children with PN-sIgE and CRD testing, of which, 98 patients had a clinical history of an IgE-mediated reaction when exposed to PN and 98 did not. The Fisher's exact test was used to assess the relationship between CRD and PN-sIgE at different cutoff levels, McNemar test and Gwet’s approach (AC1 statistic) were used to examine agreement between CRD and PN-sIgE, and logistic regression was used to assess differences in the findings between patients with and without reaction history. Results: Ara h 1, 2, 3, or 9 (ARAH) levels ≤0.35 kUA/L were significantly associated with PN-sIgE levels <2 kUA/L rather than ≥2 kUA/L (p < 0.0001). When the ARAH threshold was increased to 1 kUA/L and 2 kUA/L, these thresholds were still significantly associated with PN-sIgE levels of <2, <5, and <14 kUA/L. These findings were not significantly different in patients with and without a history of clinical reactivity. Conclusion: ARAH values correlated with PN-sIgE. Regardless of clinical history, ARAH levels are unlikely to be below 0.35, 1, or 2 kUA/L if the PN-sIgE level is >2 kUA/L. Thus, if possible, practitioners should consider PN-sIgE rather than automatically ordering CRD with PN-sIgE every time. Laboratory procedures that allow automatically and reflexively adding CRD when the PN-sIgE level is ≤5 kUA/L can be helpful. However, further studies are needed in subjects with challenge-proven PN allergy.

Stepping up detection, response, preparedness and readiness measures for “COVID-19”- A Pandemic

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1042-1047
Author(s):  
Khushbu Balsara ◽  
Deepankar Shukla
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Clinical History ◽  
Frontline Workers ◽  
Diagnostic Assays ◽  
Care Workers ◽  
Short Period ◽  
History Of ◽  
Detection Response ◽  
Care Worker

In a very short period of time, “COVID-19” has seized the consciousness globally by making remarkable changes in our day to day living and has superintended as a public health emergency globally. It has high radar of transmission, affecting an individual at work to frontline workers. The measures and planning for a response plays a key role from drawing up an emergency committee and this follows an equation which broadly deals with epidemiological to clinical history of the patient, management steps from isolation, screening, diagnostic assays for identification and treatment. The application of an organized plan with secure structure aids in better performance, increases efficacy of management and saves time. Also saves time for a health care worker to g through routine levels of channels of administration if already a familiar way of operation is known for such situations. Thus, planning and developing a ‘blueprint of approach’ towards management of patient while facing such situation is a must. This review provides an insight to the measures for detection, response and preparedness of the hospital and health care workers should largely be inclusive of; also highlights the measures to be taken at every step after coming in contact with a positive case of “COVID-19”.

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