Editing Induced coma (section)

{{Short description|Medical procedure}}
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| name         = Induced coma
| synonym      = Medically induced coma
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| specialty    = [[Neurology]]
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An '''induced coma'''{{spaced en dash}}also known as a '''medically induced coma''' ('''MIC'''), '''barbiturate-induced coma''', or '''drug-induced coma'''{{spaced en dash}}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.<ref name=Mariano2014/><ref name =An2018>{{cite journal | vauthors = An J, Jonnalagadda D, Moura V, Purdon PL, Brown EN, Westover MB | title = Variability in pharmacologically-induced coma for treatment of refractory status epilepticus | journal = PLOS ONE | volume = 13 | issue = 10 | pages = e0205789 | date = 2018 | pmid = 30379935 | pmc = 6209214 | doi = 10.1371/journal.pone.0205789 | bibcode = 2018PLoSO..1305789A | doi-access = free }}</ref>

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,<ref name =An2018/> and in [[disease#Refractory disease|refractory]] [[intracranial hypertension]] following [[traumatic brain injury]].<ref name=Mariano2014/>

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 sore]]s as well as infection from [[catheter]]s.{{citation needed|date=December 2022}}

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.<ref>{{Cite journal |last1=Eikermann |first1=Matthias |last2=Needham |first2=Dale M |last3=Devlin |first3=John W |date=May 12, 2023 |title='Multimodal, patient-centred symptom control': a strategy to replace sedation in the ICU |url=https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(23)00141-8.pdf |journal=[[The Lancet]]|volume=11 |issue=6 |pages=506–509 |doi=10.1016/S2213-2600(23)00141-8 |pmid=37187192 }}</ref>

Brain disruption from sedation can lead to an eight times<ref>{{Cite journal |last1=Pan |first1=Yanbin |last2=Yan |first2=Jianlong |last3=Jiang |first3=Zhixia |last4=Luo |first4=Jianying |last5=Zhang |first5=Jingjing |last6=Yang |first6=Kaihan |date=2019-07-10 |title=Incidence, risk factors, and cumulative risk of delirium among ICU patients: A case-control study |journal=International Journal of Nursing Sciences |volume=6 |issue=3 |pages=247–251 |doi=10.1016/j.ijnss.2019.05.008 |issn=2352-0132 |pmc=6722464 |pmid=31508442}}</ref> increased risk of the development of [[ICU delirium]]. This is associated with a doubled risk of mortality<ref>{{Cite journal |last1=Salluh |first1=Jorge I. F. |last2=Wang |first2=Han |last3=Schneider |first3=Eric B. |last4=Nagaraja |first4=Neeraja |last5=Yenokyan |first5=Gayane |last6=Damluji |first6=Abdulla |last7=Serafim |first7=Rodrigo B. |last8=Stevens |first8=Robert D. |date=2015-06-03 |title=Outcome of delirium in critically ill patients: systematic review and meta-analysis |url=https://www.bmj.com/content/350/bmj.h2538 |journal=BMJ |language=en |volume=350 |pages=h2538 |doi=10.1136/bmj.h2538 |issn=1756-1833 |pmid=26041151|pmc=4454920 }}</ref> during hospital admission. For every one day of delirium, there is a 10% increased risk of death.<ref>{{Cite journal |last1=Ely |first1=E. Wesley |last2=Shintani |first2=Ayumi |last3=Truman |first3=Brenda |last4=Speroff |first4=Theodore |last5=Gordon |first5=Sharon M. |last6=Harrell |first6=Frank E. |last7=Inouye |first7=Sharon K. |last8=Bernard |first8=Gordon R. |last9=Dittus |first9=Robert S. |date=2004-04-14 |title=Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit |url=https://pubmed.ncbi.nlm.nih.gov/15082703/ |journal=JAMA |volume=291 |issue=14 |pages=1753–1762 |doi=10.1001/jama.291.14.1753 |issn=1538-3598 |pmid=15082703}}</ref> Medically induced comas that achieve a [[Richmond Agitation-Sedation Scale|RASS]] level of −4 or −5 are an independent predictor of death.<ref>{{Cite journal |last1=Shehabi |first1=Yahya |last2=Bellomo |first2=Rinaldo |last3=Reade |first3=Michael C. |last4=Bailey |first4=Michael |last5=Bass |first5=Frances |last6=Howe |first6=Belinda |last7=McArthur |first7=Colin |last8=Seppelt |first8=Ian M. |last9=Webb |first9=Steve |last10=Weisbrodt |first10=Leonie |last11=Sedation Practice in Intensive Care Evaluation (SPICE) Study Investigators |last12=ANZICS Clinical Trials Group |date=2012-10-15 |title=Early intensive care sedation predicts long-term mortality in ventilated critically ill patients |url=https://pubmed.ncbi.nlm.nih.gov/22859526/ |journal=American Journal of Respiratory and Critical Care Medicine |volume=186 |issue=8 |pages=724–731 |doi=10.1164/rccm.201203-0522OC |issn=1535-4970 |pmid=22859526}}</ref> &nbsp;

Although patients are not sleeping while sedated, they can experience hallucinations and delusions<ref>{{Cite journal |last1=Ali |first1=Mohammed |title=ICU Delirium |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK559280/ |journal=StatPearls |access-date=2023-08-15 |place=Treasure Island, FL |publisher=StatPearls Publishing |pmid=32644706 |last2=Cascella |first2=Marco}}</ref> 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.<ref>{{Cite journal |last1=Girard |first1=Timothy D. |last2=Jackson |first2=James C. |last3=Pandharipande |first3=Pratik P. |last4=Pun |first4=Brenda T. |last5=Thompson |first5=Jennifer L. |last6=Shintani |first6=Ayumi K. |last7=Gordon |first7=Sharon M. |last8=Canonico |first8=Angelo E. |last9=Dittus |first9=Robert S. |last10=Bernard |first10=Gordon R. |last11=Ely |first11=E. Wesley |date=July 2010 |title=Delirium as a predictor of long-term cognitive impairment in survivors of critical illness |journal=Critical Care Medicine |volume=38 |issue=7 |pages=1513–1520 |doi=10.1097/CCM.0b013e3181e47be1 |issn=1530-0293 |pmc=3638813 |pmid=20473145}}</ref>

Considering the high risks of medically induced comas, protocols such as the ABCDEF Bundle<ref>{{Cite journal |last1=Pun |first1=Brenda T. |last2=Balas |first2=Michele C. |last3=Barnes-Daly |first3=Mary Ann |last4=Thompson |first4=Jennifer L. |last5=Aldrich |first5=J. Matthew |last6=Barr |first6=Juliana |last7=Byrum |first7=Diane |last8=Carson |first8=Shannon S. |last9=Devlin |first9=John W. |last10=Engel |first10=Heidi J. |last11=Esbrook |first11=Cheryl L. |last12=Hargett |first12=Ken D. |last13=Harmon |first13=Lori |last14=Hielsberg |first14=Christina |last15=Jackson |first15=James C. |date=January 2019 |title=Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults |journal=Critical Care Medicine |volume=47 |issue=1 |pages=3–14 |doi=10.1097/CCM.0000000000003482 |issn=1530-0293 |pmc=6298815 |pmid=30339549}}</ref> and PADIS guidelines<ref>{{Cite web |title=SCCM {{!}} PADIS Guidelines |url=https://sccm.org/Clinical-Resources/ICULiberation-Home/Guidelines |access-date=2023-08-15 |website=Society of Critical Care Medicine (SCCM)}}</ref> 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.&nbsp;

Survivors of prolonged medically induced comas are at high risk of suffering from post-ICU syndrome<ref>{{Citation |last1=Smith |first1=Sarah |title=Post-Intensive Care Syndrome |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK558964/ |work=StatPearls |access-date=2023-08-15 |place=Treasure Island, FL |publisher=StatPearls Publishing |pmid=32644390 |last2=Rahman |first2=Omar}}</ref> and may require extended physical, cognitive, and psychological rehabilitation.