186:
Considering the high risks of medically induced comas, protocols such as the ABCDEF Bundle and PADIS guidelines have been developed to guide ICU teams to avoid unnecessary sedation and comas. ICU teams that master these protocols to keep patients as awake and mobile as possible are called "Awake and
167:
The presence of an endotracheal tube and mechanical ventilation alone are not indications of continuous sedation and coma. Only certain conditions such as intracranial hypertension, refractory status epilepticus, the inability to oxygenate with movement, et cetera justify the high risks of medically
217:
About 60% of the glucose and oxygen used by the brain is meant for its electrical activity and the rest for all other activities such as metabolism. When barbiturates are given to brain injured patients for induced coma, they act by reducing the electrical activity of the brain, which reduces the
182:
Although patients are not sleeping while sedated, they can experience hallucinations and delusions that are often graphic and traumatizing in nature. This can lead to post-ICU PTSD after hospital discharge. Patients that develop ICU delirium are at 120 times greater risk of long-term cognitive
734:
Pun, Brenda T.; Balas, Michele C.; Barnes-Daly, Mary Ann; Thompson, Jennifer L.; Aldrich, J. Matthew; Barr, Juliana; Byrum, Diane; Carson, Shannon S.; Devlin, John W.; Engel, Heidi J.; Esbrook, Cheryl L.; Hargett, Ken D.; Harmon, Lori; Hielsberg, Christina; Jackson, James C. (January 2019).
595:
Shehabi, Yahya; Bellomo, Rinaldo; Reade, Michael C.; Bailey, Michael; Bass, Frances; Howe, Belinda; McArthur, Colin; Seppelt, Ian M.; Webb, Steve; Weisbrodt, Leonie; Sedation
Practice in Intensive Care Evaluation (SPICE) Study Investigators; ANZICS Clinical Trials Group (2012-10-15).
962:
225:
until burst suppression or cortical electrical silence (isoelectric "flatline") is attained. Once there is improvement in the patient's general condition, the barbiturates are withdrawn gradually and the patient regains consciousness.
676:
Girard, Timothy D.; Jackson, James C.; Pandharipande, Pratik P.; Pun, Brenda T.; Thompson, Jennifer L.; Shintani, Ayumi K.; Gordon, Sharon M.; Canonico, Angelo E.; Dittus, Robert S.; Bernard, Gordon R.; Ely, E. Wesley (July 2010).
233:. Some studies have found that barbiturate-induced coma can reduce intracranial hypertension but does not necessarily prevent brain damage. Furthermore, the reduction in intracranial hypertension may not be sustained. Some
218:
metabolic and oxygen demand. Their action limits oxidative damage to lipid membranes and may scavenge free radicals. They also lead to reduced vasogenic edema, fatty acid release and intracellular calcium release.
257:. If the patient survives, cognitive impairment may also follow recovery from the coma. Due to these risks, barbiturate-induced coma should be reserved for cases of refractory intracranial pressure elevation.
848:"The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Use of barbiturates in the control of intracranial hypertension".
969:
883:
Lee MW, Deppe SA, Sipperly ME, Barrette RR, Thompson DR (June 1994). "The efficacy of barbiturate coma in the management of uncontrolled intracranial hypertension following neurosurgical trauma".
175:. This is associated with a doubled risk of mortality during hospital admission. For every one day of delirium, there is a 10% increased risk of death. Medically induced comas that achieve a
1096:
Schalén W, Sonesson B, Messeter K, Nordström G, Nordström CH (1992). "Clinical outcome and cognitive impairment in patients with severe head injuries treated with barbiturate coma".
190:
Survivors of prolonged medically induced comas are at high risk of suffering from post-ICU syndrome and may require extended physical, cognitive, and psychological rehabilitation.
548:
Ely, E. Wesley; Shintani, Ayumi; Truman, Brenda; Speroff, Theodore; Gordon, Sharon M.; Harrell, Frank E.; Inouye, Sharon K.; Bernard, Gordon R.; Dittus, Robert S. (2004-04-14).
1778:
187:
Walking ICUs". These are teams that only implement medically induced comas when the possible benefits of sedation outweigh the high risks during specific cases.
1409:
214:
may be averted. Several studies have supported this theory by showing reduced mortality when treating refractory intracranial hypertension with a barbiturate coma.
491:
Salluh, Jorge I. F.; Wang, Han; Schneider, Eric B.; Nagaraja, Neeraja; Yenokyan, Gayane; Damluji, Abdulla; Serafim, Rodrigo B.; Stevens, Robert D. (2015-06-03).
1169:
140:
Induced coma usually results in significant systemic adverse effects. The patient is likely to completely lose respiratory drive and require
918:
Nordby HK, Nesbakken R (1984). "The effect of high dose barbiturate decompression after severe head injury. A controlled clinical trial".
1447:
1026:
237:
have failed to demonstrate any survival or morbidity benefit of induced coma in diverse conditions such as neurosurgical operations,
997:
1275:
1014:
The primary mechanism of protection involves a reduction in CMRo2 of up to 55% to 60% at which point the EEG becomes isoelectric.
737:"Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults"
1162:
312:
1057:"The University of Toronto head injury treatment study: a prospective, randomized comparison of pentobarbital and mannitol"
1370:
1355:
1295:
985:
approximately 60% of CMRO2 is utilized for neuronal function (with the remainder being required for cellular integrity)
300:
1768:
1465:
176:
1857:
1155:
1611:
1470:
1403:
1043:
Therapeutic EEG response: burst suppression or cortical electrical silence (with preservation of SSEP and BAEF).
1742:
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149:
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434:
Pan, Yanbin; Yan, Jianlong; Jiang, Zhixia; Luo, Jianying; Zhang, Jingjing; Yang, Kaihan (2019-07-10).
1773:
1569:
1564:
1515:
550:"Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit"
230:
130:
792:
436:"Incidence, risk factors, and cumulative risk of delirium among ICU patients: A case-control study"
598:"Early intensive care sedation predicts long-term mortality in ventilated critically ill patients"
1667:
1510:
1495:
1178:
246:
1747:
1549:
271:
222:
171:
Brain disruption from sedation can lead to an eight times increased risk of the development of
141:
134:
333:"Variability in pharmacologically-induced coma for treatment of refractory status epilepticus"
1752:
1673:
1061:
The
Canadian Journal of Neurological Sciences. Le Journal Canadien des Sciences Neurologiques
266:
207:
679:"Delirium as a predictor of long-term cognitive impairment in survivors of critical illness"
1604:
1424:
344:
1030:
392:"'Multimodal, patient-centred symptom control': a strategy to replace sedation in the ICU"
8:
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210:. The hope is that, with the swelling relieved, the pressure decreases and some or all
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493:"Outcome of delirium in critically ill patients: systematic review and meta-analysis"
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35:
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357:
84:
1055:
Schwartz ML, Tator CH, Rowed DW, Reid SR, Meguro K, Andrews DF (November 1984).
451:
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153:
145:
92:
331:
An J, Jonnalagadda D, Moura V, Purdon PL, Brown EN, Westover MB (2018).
221:
The infusion dose rate of barbiturates is increased under monitoring by
1821:
1804:
1716:
1632:
1576:
1382:
1109:
931:
399:
198:
Barbiturates reduce the metabolic rate of brain tissue, as well as the
156:
often results. The completely immobile patient is at increased risk of
100:
88:
508:
229:
Controversy exists over the benefits of using barbiturates to control
49:
1809:
1691:
1627:
390:
Eikermann, Matthias; Needham, Dale M; Devlin, John W (May 12, 2023).
104:
40:
963:"Update on Techniques for Neuroprotection during Hypothermic Arrest"
206:
in the brain narrow, resulting in a shrunken brain, and hence lower
1711:
1662:
1642:
1500:
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1194:
161:
157:
108:
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level of −4 or −5 are an independent predictor of death.
1280:
250:
968:. Society of Cardiovascular Anesthesiologists. Archived from
675:
115:
1701:
1387:
733:
490:
298:
80:
1779:
European
Society of Paediatric and Neonatal Intensive Care
602:
American
Journal of Respiratory and Critical Care Medicine
594:
330:
882:
547:
1054:
389:
1410:
Critical illness–related corticosteroid insufficiency
299:
Mariano GL, Fink ME, Hoffman C, Rosengart A (2014).
126:
that have not responded to other treatments, and in
301:"Intracranial pressure: monitoring and management."
122:, as a last line of treatment in certain cases of
152:and often requires the use of vasopressor drugs.
1844:
917:
824:, Treasure Island, FL: StatPearls Publishing,
651:. Treasure Island, FL: StatPearls Publishing.
433:
1163:
1000:. CNS Clinic – Jordan – Amman. Archived from
856:(6–7). Mary Ann Liebert, Inc.: 527–530 2000.
294:
292:
290:
288:
286:
103:. Other intravenous anesthetic drugs such as
1177:
815:
642:
303:. In Hall JB, Schmidt GA, Kress JP (eds.).
114:Drug-induced comas are used to protect the
1170:
1156:
283:
1072:
768:
710:
524:
467:
440:International Journal of Nursing Sciences
366:
356:
797:Society of Critical Care Medicine (SCCM)
326:
324:
87:) brought on by a controlled dose of an
998:"Cerebral protection and resuscitation"
643:Ali, Mohammed; Cascella, Marco (2023).
1845:
960:
1151:
321:
1658:Recombinant activated protein C
1371:Multiple organ dysfunction syndrome
1356:Acute respiratory distress syndrome
1296:Multiple organ dysfunction syndrome
816:Smith, Sarah; Rahman, Omar (2023),
148:can complicate efforts to maintain
13:
63: – also known as a
14:
1874:
1769:Society of Critical Care Medicine
1466:Ventilator-associated lung injury
1135:
79: – is a temporary
1471:Ventilator-associated pneumonia
1404:Critical illness polyneuropathy
1089:
1048:
1019:
990:
954:
911:
876:
841:
809:
785:
727:
818:"Post-Intensive Care Syndrome"
669:
636:
588:
541:
484:
427:
383:
1:
1250:Geriatric intensive-care unit
1233:Pediatric intensive care unit
413:10.1016/S2213-2600(23)00141-8
307:(4th ed.). McGraw Hill.
277:
202:. With these reductions, the
1653:Neuromuscular-blocking drugs
1596:Nutritional supplementation
1227:Neonatal intensive care unit
1029:. Trauma.org. Archived from
753:10.1097/CCM.0000000000003482
695:10.1097/CCM.0b013e3181e47be1
358:10.1371/journal.pone.0205789
7:
1753:Water-electrolyte imbalance
1587:Early goal-directed therapy
452:10.1016/j.ijnss.2019.05.008
305:Principles of Critical Care
260:
150:cerebral perfusion pressure
144:; gut motility is reduced;
10:
1879:
1605:Total parenteral nutrition
1538:Life-supporting treatments
1245:Critical illness insurance
614:10.1164/rccm.201203-0522OC
160:as well as infection from
1787:
1774:Surviving Sepsis Campaign
1761:
1725:
1682:
1620:
1570:Ventricular assist device
1565:Intra-aortic balloon pump
1536:
1516:Pulmonary artery catheter
1488:
1438:
1396:
1265:
1258:
1213:
1185:
1074:10.1017/s0317167100045960
793:"SCCM | PADIS Guidelines"
231:intracranial hypertension
193:
131:intracranial hypertension
46:
34:
26:
21:
566:10.1001/jama.291.14.1753
73:barbiturate-induced coma
1858:Intensive care medicine
1668:Stress ulcer prevention
1612:Therapeutic hypothermia
1511:Central venous catheter
1179:Intensive care medicine
897:10.1089/neu.1994.11.325
862:10.1089/neu.2000.17.527
247:intracranial hemorrhage
1743:Level of consciousness
1550:mechanical ventilation
1448:Methicillin-resistant
1142:Medically induced Coma
885:Journal of Neurotrauma
850:Journal of Neurotrauma
741:Critical Care Medicine
683:Critical Care Medicine
272:Traumatic brain injury
223:electroencephalography
142:mechanical ventilation
135:traumatic brain injury
65:medically induced coma
30:Medically induced coma
1450:Staphylococcus aureus
267:Insulin shock therapy
243:intracranial aneurysm
208:intracranial pressure
1853:Neurology procedures
1425:Stress hyperglycemia
1266:Organ system failure
1200:Medical specialities
1098:Acta Neurochirurgica
920:Acta Neurochirurgica
1788:Related specialties
1748:Acid–base imbalance
1684:ICU scoring systems
1555:Tracheal intubation
1366:Respiratory failure
1361:Acute liver failure
1351:Acute renal failure
1221:Intensive care unit
1205:Respiratory therapy
349:2018PLoSO..1305789A
200:cerebral blood flow
1697:Glasgow Coma Scale
1648:Intravenous fluids
1528:Screening cultures
1496:Arterial blood gas
1461:Refeeding syndrome
1378:Neonatal infection
1339:Vasodilatory shock
1314:Distributive shock
1239:Coronary care unit
1110:10.1007/BF01400613
1027:"Barbiturate Coma"
1004:on 4 November 2020
932:10.1007/BF01406868
255:status epilepticus
124:status epilepticus
1840:
1839:
1800:Internal medicine
1546:Airway management
1484:
1483:
1324:Obstructive shock
1309:Cardiogenic shock
1033:on 19 August 2016
560:(14): 1753–1762.
509:10.1136/bmj.h2538
314:978-0-07-173881-1
235:randomized trials
83:(a deep state of
77:drug-induced coma
57:
56:
16:Medical procedure
1870:
1561:Cardiac devices
1415:Decubitus ulcers
1329:Neurogenic shock
1263:
1262:
1172:
1165:
1158:
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1148:
1130:
1129:
1104:(3–4): 153–159.
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1087:
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1046:
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1040:
1038:
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1017:
1016:
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987:
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975:on 23 April 2016
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926:(3–4): 157–166.
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689:(7): 1513–1520.
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343:(10): e0205789.
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50:edit on Wikidata
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645:"ICU Delirium"
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1733:Hemodynamics
1707:SAPS II
1674:Vasopressors
1592:Induced coma
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1440:Iatrogenesis
1430:Stress ulcer
1334:Spinal shock
1291:Septic shock
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61:induced coma
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22:Induced coma
1815:Pulmonology
1738:Hypotension
1633:Antibiotics
1476:Dialytrauma
1319:Anaphylaxis
747:(1): 3–14.
249:, ischemic
239:head trauma
154:Hypokalemia
146:hypotension
93:barbiturate
27:Other names
1847:Categories
1822:Pediatrics
1805:Cardiology
1726:Physiology
1628:Analgesics
1577:Chest tube
1406:/ myopathy
1383:Polytrauma
1259:Conditions
835:2023-08-15
822:StatPearls
802:2023-08-15
662:2023-08-15
649:StatPearls
400:The Lancet
278:References
133:following
128:refractory
101:thiopental
89:anesthetic
1810:Neurology
1663:Sedatives
1643:Inotropes
1489:Diagnosis
761:1530-0293
703:1530-0293
622:1535-4970
574:1538-3598
517:1756-1833
503:: h2538.
460:2352-0132
245:rupture,
162:catheters
158:bed sores
105:midazolam
41:Neurology
36:Specialty
1501:Catheter
1420:Fungemia
1195:Medicine
1126:23032307
1037:16 April
1008:16 April
979:14 April
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337:PLOS ONE
261:See also
109:propofol
95:such as
1827:Surgery
1118:1414516
1083:6440704
940:6382945
905:7996586
770:6298815
712:3638813
526:4454920
469:6722464
368:6209214
345:Bibcode
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194:Theory
1670:drugs
1621:Drugs
1304:shock
1241:(CCU)
1223:(ICU)
1122:S2CID
973:(PDF)
966:(PDF)
944:S2CID
395:(PDF)
116:brain
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1863:Coma
1717:SOFA
1702:PIM2
1548:and
1388:Coma
1276:SIRS
1114:PMID
1079:PMID
1039:2016
1010:2016
981:2016
936:PMID
901:PMID
866:PMID
826:PMID
775:PMID
757:ISSN
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570:ISSN
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