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Self-Induced Comatose Patients

Some Interesting facts and findings:

 

Bispectral index (BIS) helps predicting bad neurological outcome in comatose survivors after cardiac arrest and induced therapeutic hypothermia

 

56 patients successfully resuscitated from CA were admitted during the study time period to our ICU. 47 patients fulfilled the inclusion criteria and were included. 2 patients were excluded because of a violation of the sedation protocol: 1 patient received too high doses of midazolam and 1 patient was not paralysed at all. Overall 45 patients were included in the final analysis

 

Patient characteristics and findings in patients with BIS values of 0 during their ICU stay.

No.
Pupils in ICU on day 1
SSEP
MRI/CT-scan
NSE (ng/ml)
CPC end ICU
CPC at 6 months
Cause of death
Day of death
1 Fixed mydriasis for 6 h Delayed response Severe hypoxic damage 5 Neuro (coma) withholding 22
2 a Reactive Normal Diffuse hypoxic damage 4 4
3 Fixed mydriasis for 4 h Delayed response Hypoxic lesions of thalamus 5 Neuro (coma) withholding 32
4 Fixed mydriasis 10 5 Cardiac 2
5 Mydriasis for 6 h Severe hypoxic damage 187 5 Neuro (coma) withholding 16
6 Mydriasis for 20 h Subarachnoidal haemorrhage, diffuse cerebral oedema 35 5 Brain death 2
7 Initially Reactive Severe hypoxic oedema 99 5 Brain death 3
8 a Reactive Diffuse hypoxic damage 79 5 Cardiac 5
9 Reactive Diminished amplitude Diffuse hypoxic damage 82 3 3
10 Persistant anisocoria Absent right side Frontal hypodensity 5 3 3
11 Reactive Absent left side Normal 33 4 5 Neuro (coma) withholding 129
12 Fixed mydriasis Absent Subarachnoidal haemorrhage, severe anoxic damage 25 5 Brain death 1
13 a Reactive Normal Severe hypoxic damage 87 5 Neuro (coma) withholding 12
14 Persistant anisocoria Normal Severe hypoxic damage 103 5 Neuro (coma) withholding 8
An Interesting Excerpt from an ex-comatose patient...

For six weeks in 2000 I lay in a coma in the high dependency unit of Newcastle General Hospital. I was 62 and had had a brain bleed. During that time my damaged brain made up a complex and vivid fantasy world. At first I believed I worked for an airline that flew from Hexham (a town about 20 miles west of Newcastle upon Tyne) to Charlottesville in the United States. As time passed my fantasy became more nightmarish and medical. I was in some sort of institution, in which all the nurses had Northern Irish accents. I think one of the nurses really did come from Northern Ireland, and my brain picked up this detail and generalised recklessly. In the fantasy, staff played cruel tricks, including tying my hands together. This, too, had a connection to the real world. I had many pipes plumbed into me, and once muzzily tried to pull them out. I did myself a lot of damage, and the staff tied my hands together to stop me doing it again. I fantasised about Newcastle’s Metro electric railway. In my fantasy it ran under the North Sea to Moscow, and Russian trains came along it. The Russians once held me forcibly on their part of the platform and made it hard for me to breathe. This unpleasant fantasy episode may have reflected the real world, for I had developed a chest infection. In my fantasy I plotted escapes, which always failed. In the real world two friends from the Netherlands came to visit me. My fantasy converted them into a large contingent of cyclists who had had strokes and were being treated by the NHS. Perhaps my brain was returning to reality, in associating Dutch people with bicycles and recognising I was in an NHS stroke ward. My return to full reality was slow. When my brother took me for an outing in my wheelchair I was staggered to discover I was in Newcastle. I had thought I was in Hexham. I recalled the films I had seen where someone recovers from unconsciousness to ask ‘where am I?’ It is a serious question. No one had ever thought to tell me where I was. I recovered well and today, amazingly, most of my linguistic abilities have returned. But I am always sad to hear or read of anyone unconscious or with fragmented awareness. I imagine them trapped in their internal fantasy, building on any clue from reality. Be kind to anyone in that state, even if they fail to react in any way. You may be making more of an impression than you know. David Jones is a retired staff member of the natural sciences department of Newcastle University

 

Some Interesting Facts:

The outcome of a patient can be associated with their best response in the first twenty-four hours after injury. Using the Glasgow Coma Scale (3 to 15, with 3 being a person in a coma with the lowest possible score, and 15 being a normal appearing person) research shows that if the best scale is 3 to 4 after twenty four hours, 87% of those individuals will either die or remain in a vegetative state and only 7% will had a moderate disability or good recovery. In patients with a scale from 5 to 7, 53% will die or remain in a vegetative state, while 34% will have a moderate disability and/or good recovery. In patients with a Glasgow Coma Scale of 8 to 10, 27% will die or remain in a coma, while 68% will have a moderate disability and/or good recovery. In patients who have a scale from 11 to 15, only 7% will be expected to die or remain in a coma, while 87% would expect to have at least a moderate disability and/or good recovery (remembering again that this is not an exact science).

 

Most comas end with eye opening and regaining of consciousness, however 10% of patients who open there eyes fail to regain consciousness. (Sometimes called Apallic Syndrome). These patients do not usually respond to environmental stimuli.

 

There is a syndrome which occurs in children, who after waking from the coma, display delayed recovery of consciousness in response to the psychological stresses of being in the hospital, rather then continued biological cause.

 

Studies show that patients remaining in a vegetative state for at least one year after injury are unlikely to gain consciousness, although they may live for many years.

 

90% of brain injured patients who are vegetative for one month or longer will fail to improve to a state better than severe disability. However, two thirds of patients who were unconsciousness for two weeks or less may make a moderate to good recovery.

 

 

brain  
 

Citations and Defenses

Metting, Z., Rödiger, L., Regtien, J., & van der Naalt, J. (2009, September). Delayed coma in head injury: Consider cerebral fat embolism. Clinical Neurology & Neurosurgery, 111(7), 597-600. Retrieved August 11, 2009, doi:10.1016/j.clineuro.2009.03.005


This is a defendable source because it is a case study done by a group of scientists on a first-hand basis.  Also, as stated in the article there were no apparent conflicts of interest.

Gofton, T., Chouinard, P., Young, G., Bihari, F., Nicolle, M., Lee, D., et al. (2009, June). Functional MRI study of the primary somatosensory cortex in comatose survivors of cardiac arrest. Experimental Neurology, 217(2), 320-327. Retrieved August 11, 2009, doi:10.1016/j.expneurol.2009.03.011


This is a defendable source because it is a case study done a group of scientists on a first-hand basis.  The scientists are credible and are prestigious in their professions.

Schefold, J., Storm, C., Krüger, A., Ploner, C., & Hasper, D. (2009, June). The Glasgow coma score is a predictor of good outcome in cardiac arrest patients treated with therapeutic hypothermia. Resuscitation, 80(6), 658-661. Retrieved August 11, 2009, doi:10.1016/j.resuscitation.2009.03.006

This is a defendable source because it is a clinical study done by a group of scientists on a first-hand basis.  These scientists are all part of departments that would study these types of things. 

Abusleme, I., & Chen, J. (2009, April). Alternative cerebral generators and circuitry pathways in alpha coma revealed by independent component analysis. Clinical Neurophysiology, 120(4), 686-694. Retrieved August 11, 2009, doi:10.1016/j.clinph.2008.11.025

This is a defendable source because it was a case study done by a group of scientists on a first-hand basis.  Also, the subjects with EEG pattern of alpha coma were retrospectively selected from the EEG reports at the West Los Angeles VA Medical Center according to the Institutional Review Board approved protocol.


Minardi, J., & Crocco, T. (2009, April). Management of Traumatic Brain Injury: First Link in Chain of Survival. Mount Sinai Journal of Medicine, 76(2), 138-144. Retrieved August 11, 2009, doi:10.1002/msj.20105


This is a defendable source because it was published by a journal of medicine and is a scientific look at the vegetative state.  The authors are credible college professors at prestigious universities.

Ghajar, J. (2009). Essay: The Future of Traumatic Brain Injury. . (pp. 190-193). Mount Sinai Medical Center. Retrieved August 11, 2009, doi:10.1002/msj.20095


This is a defendable source because it was published by a journal of medicine and is a scientific look at the future of TBI or traumatic brain injury.  The author is a credible college professor at prestigious hospital.


Amantini, A., Fossi, S., Grippo, A., Innocenti, P., Amadori, A., Bucciardini, L., et al. (2009, April). Continuous EEG-SEP monitoring in severe brain injury. Neurophysiologie Clinique/Clinical Neurophysiology, 39(2), 85-93. Retrieved August 11, 2009, doi:10.1016/j.neucli.2009.01.006


This is a defendable source because it was published by a medical journal and is a case study on the monitoring of severe brain injury.  The authors are international scientists from prestigious Italian hospitals. The intended audience is scholars with prior knowledge of comatose states.


Gaieski, D., Band, R., Abella, B., Neumar, R., Fuchs, B., Kolansky, D., et al. (2009, April). Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation, 80(4), 418-424. Retrieved August 11, 2009, doi:10.1016/j.resuscitation.2008.12.015


This is a defendable source because it was published by a medical journal and is a case study.  The authors are scientists from the University of Pennsylvania, a highly prestigious university. The intended audience is scholars with prior knowledge of comatose states.

Jones, D. (2008, June 18). The nightmare world of my coma. Nursing Standard, 22(41), 28-28. Retrieved August 11, 2009, from Academic Search Premier database.


This is a defendable source because it is a first-hand narrative of the implications of a comatose state.  It was also published in a nurse journal of medicine. The author is also a professor at New Castle


Iliescu, V., Dorobantu, L., Stiru, O., Bubenek, S., Miclea, I., Rugina, M., et al. (2008, June). Combined Cardiac-Neurosurgical Treatment of Acute Aortic Dissection, Stroke, and Coma. Texas Heart Institute Journal, 35(2), 200-202. Retrieved August 11, 2009, from Academic Search Premier database.


This is a defendable source because it is a first-hand account and research conducted by credible international doctors published by a medical journal.


Last revised: August 11, 2009

Järnum, H., Knutsson, L., Rundgren, M., Siemund, R., Englund, E., Friberg, H., et al. (2009, April). Diffusion and perfusion MRI of the brain in comatose patients treated with mild hypothermia after cardiac arrest: A prospective observational study. Resuscitation, 80(4), 425-430. Retrieved August 11, 2009, doi:10.1016/j.resuscitation.2009.01.004


This is a defendable source because it was published by a medical journal and is a case study.  The scientists involved were conducting first-hand research and are doctors in prestigious hospitals.


Stammet, P., Werer, C., Mertens, L., Lorang, C., & Hemmer, M. (2009, April). Bispectral index (BIS) helps predicting bad neurological outcome in comatose survivors after cardiac arrest and induced therapeutic hypothermia. Resuscitation, 80(4), 437-442. Retrieved August 11, 2009, doi:10.1016/j.resuscitation.2009.01.008


This is a defendable source because it was published by a medical journal and is a case study.  The doctor involved was conducting first-hand research.


Borgquist, O., & Friberg, H. (2009, February). Therapeutic hypothermia for comatose survivors after near-hanging—A retrospective analysis. Resuscitation, 80(2), 210-212. Retrieved August 11, 2009, doi:10.1016/j.resuscitation.2008.10.013


This is a defendable source because it was published by Resuscitation, a medical journal.  This was also a case study done by international doctors of prestigious hospitals.


Terakawa, Y., Tsuyuguchi, N., Yamamura, A., & Nakagawa, T. (2009, January). The influence of hypoglycemia on cerebral blood flow in cases of hypoglycemic coma. Neurology India, 57(1), 69-72. Retrieved August 11, 2009, doi:10.4103/0028-3886.48814
This is a defendable source because it was published by an international medical journal.  The doctors involved with this case study conducted first-hand research.


Eickhoff, S., Dafotakis, M., Grefkes, C., Stöcker, T., Shah, N., Schnitzler, A., et al. (2008, December). fMRI reveals cognitive and emotional processing in a long-term comatose patient. Experimental Neurology, 214(2), 240-246. Retrieved August 11, 2009, doi:10.1016/j.expneurol.2008.08.007


This is a defendable source because it published international medical journal.  The international doctors were involved in first-hand research.


Koutroumanidis, M., Tsatsou, K., Bonakis, A., Michael, M., & Tan, S. (2008, November). Stimulus-induced bilateral central periodic discharges, cortical myoclonus and arousal responses in mild reversible coma. Clinical Neurophysiology, 119(11), 2459-2464. Retrieved August 11, 2009, doi:10.1016/j.clinph.2008.07.278


This is a defendable source because it was published by a medical journal and was a case study performed by a group of international doctors. 


CLAASSEN, D., & RAO, S. (2008, November). Locked-in or Comatose? Clinical Dilemma in Acute Pontine Infarct. Mayo Clinic Proceedings, 83(11), 1197-1197. Retrieved August 11, 2009, from Academic Search Premier database.


This is a defendable source because it was published by a hospital journal.  This was a case study performed by a group of doctors from New York. 


Lancioni, G., Belardinelli, M., Stasolla, F., Singh, N., O’Reilly, M., Sigafoos, J., et al. (2008, August). Promoting Engagement, Requests and Choice by a Man with Post-Coma Pervasive Motor Impairment and Minimally Conscious State through a Technology-Based Program. Journal of Developmental & Physical Disabilities, 20(4), 379-388. Retrieved August 11, 2009, doi:10.1007/s10882-008-9104-x


This is a defendable source because it was published by a medical journal in August, 2008.  This is a case study conducted by a group of scientist and doctors. The intended audience is scholars with prior knowledge of comatose states.

 

Peter, J., Prabhakar, A., & Pichamuthu, K. (2008, March). Delayed-onset encephalopathy and coma in acute organophosphate poisoning in humans. NeuroToxicology, 29(2), 335-342. Retrieved August 11, 2009, doi:10.1016/j.neuro.2008.01.004


This is a defendable source because it is a case study done first-hand by doctors.


Rousseau, M., Confort-Gouny, S., Catala, A., Graperon, J., Blaya, J., Soulier, E., et al. (2008, February). A MRS-MRI-fMRI exploration of the brain. Impact of long-lasting persistent vegetative state. Brain Injury, 22(2), 123-134. Retrieved August 11, 2009, doi:10.1080/02699050801895415


This is a defendable source because it is from an academic journal entry and it is a case study done by a group of international doctors.

   
Author: Brandon Yeagley