目的:对于急性重型颅脑损伤的危重患者,意识可能会在行为反应之前重新出现。隐蔽意识的现象(即,认知运动解离)可以通过先进的神经技术来检测,例如基于任务的功能MRI(fMRI)和脑电图(EEG)。在这篇叙述性评论中,我们总结了ICU隐性意识检测的科学状态。Further,我们考虑在ICU中诊断隐性意识的预后和治疗意义,以及它可能为严重脑损伤患者继续维持生命治疗的讨论提供信息。
方法:我们回顾了有关隐性意识的重要医学文献。
方法:我们纳入了临床研究,调查了基于任务的功能磁共振成像和脑电图等先进神经技术的诊断性能特征和预后效用。我们专注于临床指南,专业社会科学声明,以及与ICU中先进神经技术的实施有关的神经伦理学分析,以检测秘密意识。
方法:我们提取了研究结果,指导方针建议,和社会关于诊断的科学声明建议,预后,隐性意识与ICU重型颅脑损伤患者临床护理的治疗相关性。
结论:新的证据表明,在行为检查中出现反应迟钝的ICU患者中,约有15-20%存在隐性意识。在创伤性和非创伤性脑损伤患者中可以检测到隐蔽意识,包括行为检查提示昏迷状态的患者。ICU中隐性意识的存在可以预测长期功能恢复的速度和程度。专业社会指南现在建议使用基于任务的功能磁共振成像和脑电图评估隐蔽意识。然而,此类研究患者选择的临床标准尚不确定,全球获得先进神经技术的机会有限.
OBJECTIVE: For critically ill patients with acute severe brain injuries,
consciousness may reemerge before behavioral responsiveness. The phenomenon of covert
consciousness (i.e., cognitive motor dissociation) may be detected by advanced neurotechnologies such as task-based functional MRI (fMRI) and electroencephalography (EEG) in patients who appear unresponsive on the bedside behavioral examination. In this narrative review, we summarize the state-of-the-science in ICU detection of covert
consciousness. Further, we consider the prognostic and therapeutic implications of diagnosing covert
consciousness in the ICU, as well as its potential to inform discussions about continuation of life-sustaining therapy for patients with severe brain injuries.
METHODS: We reviewed salient medical literature regarding covert
consciousness.
METHODS: We included clinical studies investigating the diagnostic performance characteristics and prognostic utility of advanced neurotechnologies such as task-based fMRI and EEG. We focus on clinical guidelines, professional society scientific statements, and neuroethical analyses pertaining to the implementation of advanced neurotechnologies in the ICU to detect covert consciousness.
METHODS: We extracted study results, guideline recommendations, and society scientific statement recommendations regarding the diagnostic, prognostic, and therapeutic relevance of covert consciousness to the clinical care of ICU patients with severe brain injuries.
CONCLUSIONS: Emerging evidence indicates that covert consciousness is present in approximately 15-20% of ICU patients who appear unresponsive on behavioral examination. Covert consciousness may be detected in patients with traumatic and nontraumatic brain injuries, including patients whose behavioral examination suggests a comatose state. The presence of covert consciousness in the ICU may predict the pace and extent of long-term functional recovery. Professional society guidelines now recommend assessment of covert consciousness using task-based fMRI and EEG. However, the clinical criteria for patient selection for such investigations are uncertain and global access to advanced neurotechnologies is limited.