How do people (e.g. with severe burns) get people into an artificial coma? Does this happen by constantly administering medication? And does this have long-term consequences for the patient? Because in ordinary coma patients, the duration of the coma usually means serious(er) brain damage and a more difficult rehabilitation.
Answer
Hi Natalie,
An artificial coma cannot really be compared to a coma caused by trauma, infection or lack of oxygen. In addition, in an ‘artificial’ (I think you mean a drug-induced) coma (MIC) different degrees are used. Not everyone should be kept in MIC in “the same” way.
Patients at risk of brain swelling (usually after circulatory arrest) are generally placed deepest in MIC. In addition, they are usually already in a coma because of the seizure: both forms of coma often occur together. These patients are kept in a coma with barbiturates and moderately cooled at the same time. The depth of the MIC is measured using a continuous EEG (encephalogram) and aiming for a so-called burst-suppression EEG (flat but with bursts of activity). In the meantime, the intracranial pressure (increased pressure in the skull) is also measured (with a catheter or screw), blood pressure and diuresis (excretion of urine) must be closely monitored, and hypothermia must not be maintained for too long, or there is creates a different kind of new problems.
But people can also be kept asleep because of major surgery, serious illnesses or because the lungs don’t want to cooperate for a while (as now during haemorrhagic influenza – fever caused by different virus families – or ARDS – a serious lung disease). This artificial sleeping is done with a whole range of medicines (propofol, muscle relaxants, opiates, midazolam), which means that patients receive a cocktail of relaxants, very powerful painkillers and sleeping pills via central lines (tubes in the largest veins of the body). This is done titrated (with precise determination of the concentration of a substance in a solution) because a mini-EEG (BIS) is also measured here and we keep the value tss 0.4-0.6 (1.0 = awake).
Rehabilitation has more to do with the underlying reason why someone was kept in MIC, but of course – the longer such an MIC is kept – the more difficult a patient sometimes has to get back on their feet. Modern ventilators are therefore designed to use fewer muscle relaxants and to ventilate more synchronously, so that the respiratory muscles are less ‘untrained’. The difficulty of getting long-term ventilated patients off a machine is familiar to every ICU physician and VP (weaning-off process) and is often an arduous process of trial and error.
Greetings,
Dirk Danschieter, MScN, Assistant Clinical Law VUB
Answered by
MSc Dirk Danschieter
Itensive care children – humanitarian disasters and field hospitals – plasticizers and plasticizers in medical material and the effect on the body
Pleinlaan 2 1050 Ixelles
http://www.vub.ac.be/
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