Evaluating the Potential for Recovery of Consciousness in the Intensive Care Unit

Evaluating patients in the intensive care unit (ICU) with disorders of consciousness has prognostic implications. When brainstem functions are intact, the neurologist must use ancillary testing to help determine prognosis. This article addresses the challenges of arriving at prognoses in patients with hypoxic-ischemic encephalopathy and traumatic brain injury (TBI) and discusses strategies for dealing with these challenges. This has some relevance to other conditions that are capable of causing irreversible brain damage.

Although practice parameters formulated by an American Academy of Neurology (AAN) subcommittee in 2006 were reliable for evaluating patients with hypoxic-ischemic encephalopathy who did not receive hypothermia, the advent of hypothermia has shown that some of these prognostic features were unreliable. Some patients with TBI thought to be vegetative have been found to have cognitive responses. These revelations require neurologists to reconsider prognostic strategies.

To arrive at a more accurate prognosis, it is best to employ multiple pieces of evidence and incorporate the most updated information from the literature. In some cases, newer technologies can provide further insights into cortical function in behaviorally unresponsive patients.