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Хронические нарушения сознания: клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов»
Chronic disorders of consciousness (DOC) represent severe
central nervous system damage resulting in long-term disability
and a significant burden to healthcare institutions and patients’
families. DOC develop in patients after coma and are characterized
by the presence of wakefulness with complete or almost
complete absence of signs of awareness. DOC include vegetative
state (VS) and minimally conscious state (MCS). The term
prolonged disorders of consciousness (pDOC) is also used
in the Russian literature to describe the initial stages of chronic
DOC. Another clinical entity, exit from MCS, is used to characterize
the stage of recovery of cognitive functions. Diagnosis
of DOC is based on repeated structured clinical examination
using specific scales, provided that reversible causes of impaired
consciousness are excluded. Treatment of DOC patients
includes maintenance of vital functions and optimal nutrition
and control of typical complications and concomitant conditions
(pressure sores, spasticity, pain, paroxysmal sympathetic
hyperactivity, etc.). Rehabilitation of DOC patients should
involve a multidisciplinary rehabilitation team, the extent
of which is determined by the individual problems and capabilities
of the patient. Rehabilitation is most effective if started
early. To date, there is no robust evidence on the effectiveness
of specific methods for restoring consciousness, while a number
of pharmacological and non-pharmacological interventions
are being studied; however, they should be applied provided
that the maximum possible level of correction of the patient’s
somatic problems is achieved. The family plays a key role in rehabilitation.
They need practical information about their loved
one’s condition, guidance in rehabilitation, and psychological
support.