[Problems of surveillance and nursing in chronic coma]

Impaired consciousness after severe brain damage is coma, the next step being vegetative state with a high mortality rate. Some vegetative patients may in fact improve, although they usually stay dependent. The entire attending and rehabilitation team looks for responses to simple orders, which mean return of consciousness, and watches the patient's articular state and potential complications. It is also necessary to maintain the patient's dignity at this stage of wakefulness without awareness, and to prevent neuro-orthopaedic and cutaneous complications by positions and mobilizations, in order to provide optimal conditions for a possible physical and/or mental recovery and to reduce the degree of dependence.