Chronic Disorders of Consciousness: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”

Author:

Belkin A. A.1ORCID,Aleksandrova E. V.2ORCID,Akhutina T. V.3ORCID,Belkin V. A.4ORCID,Berdnikovich E. S.5ORCID,Bykova V. I.6ORCID,Varako N. A.7ORCID,Voznyuk I. A.8ORCID,Gnedovskaya E. V.5ORCID,Grigoryeva V. N.9ORCID,Zaytsev O. S.2ORCID,Zinchenko Yu. P.3ORCID,Ivanova G. E.10ORCID,Ivanova N. E.11ORCID,Kovyazina M. S.12ORCID,Kondratyev A. N.11ORCID,Kondratyeva E. A.13ORCID,Kondratyev S. A.11ORCID,Krylov V. V.14ORCID,Latyshev Ya. A.2ORCID,Lebedinskii K. M.15ORCID,Legostaeva L. A.5ORCID,Maksakova O. A.2ORCID,Martynov M. Yu.10ORCID,Mikadze Yu. V.3ORCID,Petrikov S. S.14ORCID,Petrova M. V.12ORCID,Piradov M. A.5ORCID,Popugaev K. A.14ORCID,Pryanikov I. V.12ORCID,Ryabinkina Yu. V.5ORCID,Savin I. A.2ORCID,Sergeev Dmitry V.5ORCID,Sinkin M. V.14ORCID,Skvortsov A. A.16ORCID,Skripay E. Yu.2ORCID,Suvorov A. Yu.17ORCID,Suponeva N. A.5ORCID,Usachev D. Yu.2ORCID,Fufaeva E. V.6ORCID,Shamalov N. A.17ORCID,Shchegolev A. V.13ORCID,Iazeva E. G.18ORCID,Zabolotskikh I. B.19ORCID

Affiliation:

1. Clinical Institute of Brain, Yekaterinburg, Russia; Ural State Medical University, Yekaterinburg, Russia

2. National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Russia

3. Lomonosov Moscow State University, Moscow, Russia

4. Clinical Institute of Brain, Yekaterinburg, Russia

5. Research Center of Neurology, Moscow, Russia

6. Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russia

7. Lomonosov Moscow State University, Moscow, Russia; Research Center of Neurology, Moscow, Russia; Psychological Institute of the Russian Academy of Education, Moscow, Russia

8. I.I. Dzhanelidze Research Institute of Emergency Care, St. Petersburg, Russia

9. Privolzhsky Research Medical University, Nizhny Novgorod, Russia

10. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia

11. Polenov Neurosurgical Institute, St. Petersburg, Russia

12. Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia

13. Military Medical Academy, St. Petersburg, Russia

14. N.V. Sklifosovskii Research Institute for Emergency Medicine of Moscow Healthcare Department, Moscow, Russia

15. Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

16. National Research University Higher School of Economics, Moscow, Russia

17. Federal Center of Brain Research and Neurotechnologies, Moscow, Russia

18. Three Sisters Rehabilitation Center, Moscow region, Moscow, Russia

19. Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; Kuban State Medical University, Krasnodar, Russia

Abstract

Chronic disorders of consciousness (DOC) represent severe central nervous system damage resulting in long-term disability and a significant burden to healthcare institutions and patientsʼ families. DOC develop in patients after coma and are characterized by the presence of wakefulness with complete or almost complete absence of signs of awareness. DOC include vegetative state (VS) and minimally conscious state (MCS). The term prolonged disorders of consciousness (pDOC) is also used in the Russian literature to describe the initial stages of chronic DOC. Another clinical entity, exit from MCS, is used to characterize the stage of recovery of cognitive functions. Diagnosis of DOC is based on repeated structured clinical examination using specific scales, provided that reversible causes of impaired consciousness are excluded. Treatment of DOC patients includes maintenance of vital functions and optimal nutrition and control of typical complications and concomitant conditions (pressure sores, spasticity, pain, paroxysmal sympathetic hyperactivity, etc.). Rehabilitation of DOC patients should involve a multidisciplinary rehabilitation team, the extent of which is determined by the individual problems and capabilities of the patient. Rehabilitation is most effective if started early. To date, there is no robust evidence on the effectiveness of specific methods for restoring consciousness, while a number of pharmacological and non-pharmacological interventions are being studied; however, they should be applied provided that the maximum possible level of correction of the patientʼs somatic problems is achieved. The family plays a key role in rehabilitation. They need practical information about their loved oneʼs condition, guidance in rehabilitation, and psychological support.

Publisher

Practical Medicine Publishing House

Subject

Law,Anesthesiology and Pain Medicine,Critical Care and Intensive Care Medicine,Emergency Medical Services

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