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Related Experiment Video

Updated: Jun 16, 2025

SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients
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Covert Consciousness in the ICU.

Brian L Edlow1,2, David K Menon3

  • 1Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Critical Care Medicine
|August 15, 2024
PubMed
Summary
This summary is machine-generated.

Covert consciousness, detected by advanced neuroimaging, is present in 15-20% of unresponsive ICU patients with severe brain injuries. This finding impacts prognosis and treatment decisions, guiding life-sustaining therapy discussions.

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Neuroimaging

Background:

  • Critically ill patients with severe brain injuries may exhibit covert consciousness (cognitive-motor dissociation) despite appearing behaviorally unresponsive.
  • Advanced neurotechnologies like functional MRI (fMRI) and electroencephalography (EEG) can detect this hidden awareness.

Purpose of the Study:

  • To review the current scientific understanding of detecting covert consciousness in intensive care units (ICUs).
  • To explore the prognostic and therapeutic implications of identifying covert consciousness.
  • To inform discussions regarding life-sustaining therapy for patients with severe brain injuries.

Main Methods:

  • A narrative review of salient medical literature.
  • Inclusion of clinical studies on diagnostic performance and prognostic utility of task-based fMRI and EEG.
  • Focus on clinical guidelines, professional society statements, and neuroethical analyses for ICU implementation.

Main Results:

  • Covert consciousness is detected in approximately 15-20% of unresponsive ICU patients with severe brain injuries (traumatic and non-traumatic).
  • The presence of covert consciousness can predict long-term functional recovery.
  • Professional societies recommend assessing covert consciousness using fMRI and EEG.

Conclusions:

  • While guidelines recommend advanced neuroimaging for covert consciousness, patient selection criteria remain unclear.
  • Limited global access to neurotechnologies poses a challenge for widespread implementation.
  • Diagnosing covert consciousness has significant prognostic and therapeutic implications in critical care.