Measuring Consciousness in the Intensive Care Unit

Edlow, Brian L.; Fecchio, Matteo; Bodien, Yelena; Comanducci, Angela; Rosanova, Mario; Casarotto, Silvia; Young, Michael J.; Li, Jian; Dougherty, Darin D.; Koch, Christof; Tononi, Giulio; Massimini, Marcello; Boly, Mélanie

doi:10.1007/s12028-023-01706-4

Cited by 23 publications

(12 citation statements)

References 75 publications

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“…Recently, a synthetic index accounting for brain complexity as measured by TMS‐EEG, called PCI, has been computed and validated (Casali et al, 2013; Casarotto et al, 2016; see also in Comolatti et al, 2019, a computationally different measure of perturbational complexity that holds for other types of brain signals beyond TMS‐EEG recordings), showing the ability to discriminate the presence of consciousness with high accuracy, sensitivity, and specificity also for prognostic purposes (Casali et al, 2013; Casarotto et al, 2016; Rosanova et al, 2018). In this regard, the use of TMS‐EEG in acute DoC patients offers an intriguing new perspective (Edlow et al, 2023). The application of TMS‐EEG, as well as of other multimodal approaches, in acute DoC patients is indeed limited due to obvious logistical, technical and methodological issues.…”

Section: Discussionmentioning

confidence: 99%

Multimodal approaches supporting the diagnosis, prognosis and investigation of neural correlates of disorders of consciousness: A systematic review

Gallucci,

Varoli,

Del Mauro

et al. 2023

Eur J of Neuroscience

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The limits of the standard, behaviour‐based clinical assessment of patients with disorders of consciousness (DoC) prompted the employment of functional neuroimaging, neurometabolic, neurophysiological and neurostimulation techniques, to detect brain‐based covert markers of awareness. However, uni‐modal approaches, consisting in employing just one of those techniques, are usually not sufficient to provide an exhaustive exploration of the neural underpinnings of residual awareness. This systematic review aimed at collecting the evidence from studies employing a multimodal approach, that is, combining more instruments to complement DoC diagnosis, prognosis and better investigating their neural correlates. Following the PRISMA guidelines, records from PubMed, EMBASE and Scopus were screened to select peer‐review original articles in which a multi‐modal approach was used for the assessment of adult patients with a diagnosis of DoC. Ninety‐two observational studies and 32 case reports or case series met the inclusion criteria. Results highlighted a diagnostic and prognostic advantage of multi‐modal approaches that involve electroencephalography‐based (EEG‐based) measurements together with neuroimaging or neurometabolic data or with neurostimulation. Multimodal assessment deepened the knowledge on the neural networks underlying consciousness, by showing correlations between the integrity of the default mode network and the different clinical diagnosis of DoC. However, except for studies using transcranial magnetic stimulation combined with electroencephalography, the integration of more than one technique in most of the cases occurs without an a priori‐designed multi‐modal diagnostic approach. Our review supports the feasibility and underlines the advantages of a multimodal approach for the diagnosis, prognosis and for the investigation of neural correlates of DoCs.

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Section: Discussionmentioning

confidence: 99%

Multimodal approaches supporting the diagnosis, prognosis and investigation of neural correlates of disorders of consciousness: A systematic review

Gallucci,

Varoli,

Del Mauro

et al. 2023

Eur J of Neuroscience

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“…A combination of EEG with TMS may enhance diagnostic sensitivity and mitigate common confounders in ICU environments. 15 This approach, which involves directly exciting neurons using TMS and measuring the brain's response via EEG, allows for quantifiable interpretation. TMS-EEG appears to offer several advantages: it neither rely on the integrity of the sensory or motor systems nor on the cognitive function of the patient, and it provides insights into overall brain dynamics.…”

Section: Advancing Imaging Modalities and Electrophysiology In Practicementioning

confidence: 99%

An Update on Curing Coma Campaign

Kim,

Polizzotto,

Suarez

et al. 2024

Semin Neurol

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The Curing Coma Campaign (CCC) and its contributing collaborators identified multiple key areas of knowledge and research gaps in coma and disorders of consciousness (DoC). This step was a crucial effort and essential to prioritize future educational and research efforts. These key areas include defining categories of DoC, assessing DoC using multimodal approach (e.g., behavioral assessment tools, advanced neuroimaging studies), discussing optimal clinical trials' design and exploring computational models to conduct clinical trials in patients with DoC, and establishing common data elements to standardize data collection. Other key areas focused on creating coma care registry and educating clinicians and patients and promoting awareness of DoC to improve care in patients with DoC. The ongoing efforts in these key areas are discussed.

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“…In previous studies, early restoration of consciousness was deemed a pivotal factor in forecasting long-term improvement in functionality [ 20 ]. Some patients with brain damage may retain covert consciousness, potentially possessing higher levels of consciousness than what is assessed through behavioral evaluation.…”

Section: Bci As a Communication Tool In The Icumentioning

confidence: 99%

“…Thus, BCI can guide more tailored treatment approaches and prognosis estimation [ 22 ]. Edlow et al [ 20 ] advocated for implementation of transcranial magnetic stimulation electroencephalography in ICUs as a revolutionary approach to assess consciousness in severely brain-injured patients. That approach overcomes the limitations of measuring only EEG signals and more effectively guides ethical decision-making in patient care.…”

Section: Bci As a Communication Tool In The Icumentioning

confidence: 99%

Brain–computer interface in critical care and rehabilitation

Oh,

Shin,

Kim

2024

ACC

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This comprehensive review explores the broad landscape of brain–computer interface (BCI) technology and its potential use in intensive care units (ICUs), particularly for patients with motor impairments such as quadriplegia or severe brain injury. By employing brain signals from various sensing techniques, BCIs offer enhanced communication and motor rehabilitation strategies for patients. This review underscores the concept and efficacy of noninvasive, electroencephalogram-based BCIs in facilitating both communicative interactions and motor function recovery. Additionally, it highlights the current research gap in intuitive “stop” mechanisms within motor rehabilitation protocols, emphasizing the need for advancements that prioritize patient safety and individualized responsiveness. Furthermore, it advocates for more focused research that considers the unique requirements of ICU environments to address the challenges arising from patient variability, fatigue, and limited applicability of current BCI systems outside of experimental settings.

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Measuring Consciousness in the Intensive Care Unit

Cited by 23 publications

References 75 publications

Multimodal approaches supporting the diagnosis, prognosis and investigation of neural correlates of disorders of consciousness: A systematic review

Multimodal approaches supporting the diagnosis, prognosis and investigation of neural correlates of disorders of consciousness: A systematic review

An Update on Curing Coma Campaign

Brain–computer interface in critical care and rehabilitation

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