The diagnosis and prognosis of disorders of consciousness (DOC) such as coma, unresponsive wakefulness syndrome, or minimally conscious state are especially challenging in children. In some paediatric patients with severe acquired brain injury, medical comorbidities or developmental factors may obscure the detection of signs of consciousness via clinical assessments, thus leading to misdiagnosis. To circumvent these biases, patients benefit from multimodal assessments that combine behavioural, neuroimaging, and neurophysiological measures. In this review, we provide original data for such diagnostic procedures in children. Neuroimaging is largely underdocumented in children and most neurophysiological research consists of a cohort study design aimed at providing prognostic markers for clinical outcomes. The scarcity of available data on complementary diagnostic approaches in children makes it difficult to establish clear paediatric guidelines. Although there is preliminary evidence for the applicability of paradigms involving event‐related potentials as support for diagnosis in children, more well‐designed studies need to be conducted to promote evidence‐based practices in paediatric DOC.

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The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.

Purpose: Communication with patients undergoing mechanical ventilation in the intensive care unit represents a challenge. The aims of the study were (1) to describe communication difficulties related to mechanical ventilation as experienced by caregivers and patients, and (2) to compare the use of a conventional low-tech communication board and a high-tech eye tracking technology-based device in order to improve communication effectiveness of mechanically ventilated patients in intensive care. Methods: This prospective study consisted of a descriptive cross-sectional part describing the communication difficulties in the intensive care unit and an experimental randomized crossover part comparing the use of two technologically opposed augmentative and alternative communication interfaces. A mixed method approach was applied with a quantitative primary method and a qualitative complementary method. Results: A total of 101 caregivers and 44 patients participated. Regarding the descriptive part, the communication difficulty analysis confirmed that mechanical ventilation constitutes a major problem in patient-caregiver communication. Regarding the quantitative experimental part, the treatment effects on transmitted messages quantity (2 median messages per exchange for the board versus 4 median messages per exchange for the eye tracking, p < 0.0001), success rate (80% for the board versus 100% for the eye tracking, p < 0.05) and patient satisfaction (68% negative satisfaction level for the board versus 100% positive satisfaction level for eye tracking, p < 0.0001) were significant. Regarding the qualitative experimental part, the communication content covered 8 themes for the board compared to 9 themes for the eye tracking and he use difficulties included 4 categories for the board as well as for the eye tracking. Conclusion: The eye tracking device may improve communication effectiveness of mechanically ventilated patients compared to the conventional communication board, both quantitatively and qualitatively.

Background: Communication with patients undergoing mechanical ventilation in the intensive care unit represents a challenge. The aims of the study were (1) to describe communication difficulties related to mechanical ventilation as experienced by healthcare professionals and patients, and (2) to compare the use of a conventional low-tech communication board and a high-tech eye tracking technology-based device to improve communication effectiveness of mechanically ventilated patients in intensive care. Methods: This prospective study consisted of a descriptive cross-sectional part describing the communication difficulties in the intensive care unit and an experimental randomized crossover part comparing the use of two technologically opposed augmentative and alternative communication interfaces. A mixed method approach was applied with a quantitative primary method and a qualitative complementary method. The numerical data were analyzed quantitatively using Mann-Whitney (ordinal variables) and chi-square (binary variables) nonparametric tests. The non-numerical data were analyzed qualitatively using thematization and categorization. Results: A total of 101 healthcare professionals and 44 patients participated. Regarding the descriptive part, the communication difficulty analysis confirmed that mechanical ventilation constitutes a major problem in patient-caregiver communication. Regarding the quantitative experimental part, the treatment effects on transmitted messages quantity (2 median messages per exchange for the board versus 4 median messages per exchange for the eye tracking, p < 0.0001), success rate (80% for the board versus 100% for the eye tracking, p < 0.05) and patient satisfaction (68% negative satisfaction level for the board versus 100% positive satisfaction level for eye tracking, p < 0.0001) were significant. Regarding the qualitative experimental part, the communication content covered 8 themes for the board compared to 9 themes for the eye tracking and the use difficulties included 4 categories for the board as well as for the eye tracking. Conclusion: The eye tracking device may further improve communication effectiveness of mechanically ventilated patients compared to the conventional communication board, both quantitatively and qualitatively. Trial registration: Communication Strategies for Mechanically Ventilated Patients in Intensive Care Units, NCT05651984. Retrospectively registered on December 02, 2022 (https://clinicaltrials.gov/ct2/show/NCT05651984?term=NCT05651984&draw=2&rank=1).