Acute brain injury; Cognitive motor dissociation; Coma; Disorders of consciousness; Ethical decision-making; Intensive care; Minimally conscious state; Neuroprognostication; Unresponsive wakefulness syndrome; Vegetative state; Critical Care and Intensive Care Medicine
Abstract :
[en] Disorders of consciousness (DoC) represent a spectrum of clinical conditions, including coma, unresponsive wakefulness syndrome, and the minimally conscious state, which may result from structural and non-structural brain injuries due to trauma, stroke, anoxia, infections of the brain, and other causes. Clinical management of patients with DoC is especially challenging in the critical care environment, where the level of consciousness, a key factor in determining the trajectory of recovery, may be obscured by sedation, analgesia, and other confounders. The 2025 International Symposium on Intensive Care and Emergency Medicine hosted a Roundtable of 18 expert clinicians and researchers to synthesise and discuss the latest evidence on acute DoC epidemiology, diagnosis, treatment, and prognosis. Here, we summarise the output of the Roundtable in the format of a roadmap with six steps related to identifying patients with DoC, assessing for and treating confounders, establishing a diagnosis and prognosis, selecting interventions, and effectively communicating with family. This roadmap provides practical, evidence-informed guidance to help intensivists navigate diagnosis, treatment, and prognostication in patients with acute DoC. Advances in structural and functional neuroimaging, electrophysiology, and blood-based biomarkers offer promise for refined diagnostics and prognostication, though their clinical translation remains limited.
Disciplines :
Neurosciences & behavior
Author, co-author :
Bodien, Yelena G ; Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, USA. yelena.bodien@vumc.org ; Division of Acute Care Surgery, Department of Surgery, Department of Neurological Surgery, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA. yelena.bodien@vumc.org
Busl, Katharina M ; Division of Neurocritical Care, Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
Chang, Cherylee W J; Division of Neurocritical Care, Departments of Neurology, Neurosurgery, Medicine, Duke University, Durham, NC, USA
Claassen, Jan ; Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
Gaspard, Nicolas; Service de Neurologie, Hôpital Universitaire de Bruxelles-Université Libre de Bruxelles, Brussels, Belgium ; Neurology Department, Yale University School of Medicine, New Haven, CT, USA
Gosseries, Olivia ; Université de Liège - ULiège > GIGA > GIGA Neurosciences - Coma Science Group
Helbok, Raimund ; Department of Neurology, Kepler University Hospital, Johannes Kepler University, Linz, Austria ; Clinical Research Institute of Neuroscience, Kepler University Hospital, Johannes Kepler University, Linz, Austria
Massimini, Marcello; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy ; Istituto Di Ricovero E Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
Naccache, Lionel; DMU Neurosciences-Clinical Neurophysiology, Paris Brain Institute-ICM, Inserm, CNRS, PICNIC-Lab, Sorbonne Université, APHP, Hôpital de La Pitié Salpêtrière, Paris, France
Newcombe, Virginia ; Department of Medicine, University of Cambridge, Cambridge, UK
Robba, Chiara; IRCCS Policlinico San Martino, Genoa, Italy ; Dipartimento di Scienze Chirurgiche Diagnostiche e Integrated, University of Genova, Genova, Italy
Rohaut, Benjamin; DMU Neurosciences-Neuro ICU, Inserm, CNRS, PICNIC-Lab, Paris Brain Institute-ICM, Sorbonne Université, APHP, Hôpital de La Pitié Salpêtrière, Paris, France
Suarez, Jose I; Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Turgeon, Alexis F; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval Research Center, Université Laval, Québec City, QC, Canada ; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada
Vespa, Paul; Departments of Neurosurgery and Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Wahlster, Sarah; Departments of Neurology, Neurosurgery, and Anesthesiology, Harborview Medical Center, University of Washington, Washington, USA
Taccone, Fabio Silvio; Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
Citerio, Giuseppe ; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy ; NeuroIntensive Care Unit, Department Neuroscience, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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