Global InformationInduced coma information
| Induced coma | |
|---|---|
| Other names | Medically induced coma |
| Specialty | Neurology |
An induced coma – also known as a medically induced coma (MIC), barbiturate-induced coma, or drug-induced coma – is a temporary coma (a deep state of unconsciousness) brought on by a controlled dose of an anesthetic drug, often a barbiturate such as pentobarbital or thiopental. Other intravenous anesthetic drugs such as midazolam or propofol may be used.[1][2]
Drug-induced comas are used to protect the brain during major neurosurgery, as a last line of treatment in certain cases of status epilepticus that have not responded to other treatments,[2] and in refractory intracranial hypertension following traumatic brain injury.[1]
Induced coma usually results in significant systemic adverse effects. The patient is likely to completely lose respiratory drive and require mechanical ventilation; gut motility is reduced; hypotension can complicate efforts to maintain cerebral perfusion pressure and often requires the use of vasopressor drugs. Hypokalemia often results. The completely immobile patient is at increased risk of bed sores as well as infection from catheters.[citation needed]
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 induced comas.[3]
Brain disruption from sedation can lead to an eight times[4] increased risk of the development of ICU delirium. This is associated with a doubled risk of mortality[5] during hospital admission. For every one day of delirium, there is a 10% increased risk of death.[6] Medically induced comas that achieve a RASS level of −4 or −5 are an independent predictor of death.[7]
Although patients are not sleeping while sedated, they can experience hallucinations and delusions[8] 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 impairments.[9]
Considering the high risks of medically induced comas, protocols such as the ABCDEF Bundle[10] and PADIS guidelines[11] 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 Walking ICUs". These are teams that only implement medically induced comas when the possible benefits of sedation outweigh the high risks during specific cases.
Survivors of prolonged medically induced comas are at high risk of suffering from post-ICU syndrome[12] and may require extended physical, cognitive, and psychological rehabilitation.
- ^ a b Cite error: The named reference
Mariano2014was invoked but never defined (see the help page). - ^ a b An J, Jonnalagadda D, Moura V, Purdon PL, Brown EN, Westover MB (2018). "Variability in pharmacologically-induced coma for treatment of refractory status epilepticus". PLOS ONE. 13 (10): e0205789. Bibcode:2018PLoSO..1305789A. doi:10.1371/journal.pone.0205789. PMC 6209214. PMID 30379935.
- ^ Eikermann, Matthias; Needham, Dale M; Devlin, John W (May 12, 2023). "'Multimodal, patient-centred symptom control': a strategy to replace sedation in the ICU" (PDF). The Lancet.
- ^ Pan, Yanbin; Yan, Jianlong; Jiang, Zhixia; Luo, Jianying; Zhang, Jingjing; Yang, Kaihan (2019-07-10). "Incidence, risk factors, and cumulative risk of delirium among ICU patients: A case-control study". International Journal of Nursing Sciences. 6 (3): 247–251. doi:10.1016/j.ijnss.2019.05.008. ISSN 2352-0132. PMC 6722464. PMID 31508442.
- ^ Salluh, Jorge I. F.; Wang, Han; Schneider, Eric B.; Nagaraja, Neeraja; Yenokyan, Gayane; Damluji, Abdulla; Serafim, Rodrigo B.; Stevens, Robert D. (2015-06-03). "Outcome of delirium in critically ill patients: systematic review and meta-analysis". BMJ. 350: h2538. doi:10.1136/bmj.h2538. ISSN 1756-1833. PMC 4454920. PMID 26041151.
- ^ 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). "Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit". JAMA. 291 (14): 1753–1762. doi:10.1001/jama.291.14.1753. ISSN 1538-3598. PMID 15082703.
- ^ 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). "Early intensive care sedation predicts long-term mortality in ventilated critically ill patients". American Journal of Respiratory and Critical Care Medicine. 186 (8): 724–731. doi:10.1164/rccm.201203-0522OC. ISSN 1535-4970. PMID 22859526.
- ^ Ali, Mohammed; Cascella, Marco (2023). "ICU Delirium". StatPearls. Treasure Island, FL: StatPearls Publishing. PMID 32644706. Retrieved 2023-08-15.
- ^ 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). "Delirium as a predictor of long-term cognitive impairment in survivors of critical illness". Critical Care Medicine. 38 (7): 1513–1520. doi:10.1097/CCM.0b013e3181e47be1. ISSN 1530-0293. PMC 3638813. PMID 20473145.
- ^ 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). "Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults". Critical Care Medicine. 47 (1): 3–14. doi:10.1097/CCM.0000000000003482. ISSN 1530-0293. PMC 6298815. PMID 30339549.
- ^ "SCCM | PADIS Guidelines". Society of Critical Care Medicine (SCCM). Retrieved 2023-08-15.
- ^ Smith, Sarah; Rahman, Omar (2023), "Post-Intensive Care Syndrome", StatPearls, Treasure Island, FL: StatPearls Publishing, PMID 32644390, retrieved 2023-08-15