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Approach to the comatose patient

Stevens, Robert D. MD; Bhardwaj, Anish MD, FCCM

doi: 10.1097/01.CCM.0000194534.42661.9F
Continuing Medical Education Articles

Background: Coma is a medical emergency and may constitute a diagnostic and therapeutic challenge for the intensivist.

Objective: To review currently available data on the etiology, diagnosis, and outcome of coma. To propose an evidence-based approach for the clinical management of the comatose patient.

Data Source: Search of Medline and Cochrane databases; manual review of bibliographies from selected articles and monographs.

Data Synthesis and Conclusions: Coma and other states of impaired consciousness are signs of extensive dysfunction or injury involving the brainstem, diencephalon, or cerebral cortex and are associated with a substantial risk of death and disability. Management of impaired consciousness includes prompt stabilization of vital physiologic functions to prevent secondary neurologic injury, etiological diagnosis, and the institution of brain-directed therapeutic or preventive measures. Neurologic prognosis is determined by the underlying etiology and may be predicted by the combination of clinical signs and electrophysiological tests.

LEARNING OBJECTIVES: On completion of this article, the reader should be able to:

1. Describe changes in the level of consciousness.

2. Identify the indicators of prognosis in comatose patients.

3. Use this information in a clinical setting.

Dr. Stevens has disclosed that he is the recipient of direct grant/research funds from the National Institutes of Health, Public Health Service; Dr. Bhardwaj has disclosed that he was the recipient of direct grant/research funds from the American Heart Association and that he is/was the recipient of grant/research funds from the National Institutes of Health, Public Health Service.

Wolters Kluwer Health has identified and resolved all faculty conflicts of interests regarding this educational activity.

Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information in obtaining continuing medical education credit.

Assistant Professor, Division of Neurosciences Critical Care, Department of Anesthesiology/Critical Care Medicine, Neurology and Neurosurgery (RDS), Vice Chairman, Department of Neurology, Co-Director, Division of Neurosciences Critical Care, Associate Professor of Neurology, Neurological Surgery, Anesthesiology/Critical Care Medicine (AB), The Johns Hopkins University School of Medicine, Baltimore, MD.

Supported, in part, by grant NS 046379 from the U.S. Public Health Service National Institutes of Health.

© 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins