Reflections on Consciousness in Intensive Care

Evaluating consciousness in intensive care is pivotal to relieving suffering with analgesic or sedative drugs and in prognosis and diagnoses. The usual clinical perspective is to equate consciousness with responsiveness, assuming functional motor responses and sympathetic activity of the patient. Clinical diagnoses of coma may be wrong in more than 15% of cases and are particularly challenging in neonatal and paediatric patients. In this narrative review, we present monitoring techniques, possible treatments and ethical implications of disorders of consciousness. Finally, models for understanding the origin of consciousness based on functional neuroanatomy and information processing theory are presented.