NEW TAXONOMY FOR PROLONGED DISORDERS OF CONSCIOUSNESS MAY HELP WITH DECISIONS ON WITHDRAWAL OF CLINICALLY ASSISTED NUTRITION AND HYDRATION: A PROPOSED DECISION-MAKING PATHWAY

Autores da FMUP

• Rui Manuel Lopes Nunes

  Autor

Participantes de fora da FMUP

• Teixeira, LD
• Rocha, NB

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

The number of patients surviving severe brain injury is increasing; however, many are left in a prolonged disorder of consciousness. With appropriate tre- atment, patients with prolonged disorders of con- sciousness can survive for years. Unless an advance directive exists, the treating clinicians can authorize withdrawal of clinically assisted nutrition and hydra- tion for these patients, based on best interests. The classic terminology used in prolonged disorders of consciousness ranges from coma, vegetative state to minimally conscious state. However, a new group of patients with covert cognition has been identified in the last decade, making it necessary to revise the current taxonomy to better reflect our understand- ing of these conditions. With the introduction of a less ambiguous terminology, the challenges when it comes to withdrawal of clinically assisted nutrition and hydration of these patients may ease. A decision making pathway for withdrawal of clinically assisted nutrition and hydration for patients with prolonged disorders of consciousness, based on a new tax- onomy is proposed. These decisions should be based primarily on best interests. The adoption of a new classification for impairments of consciousness would clarify and improve how we think about these patients. Moreover, the development of accurate prognostic predictors would be a major step in the decision -making process, as it would influence the beneficent pathway towards the best clinical out- come.

Keywords

• clinically assisted nutrition and hydration; consciousness; covert cognition; decision-making; minimally conscious state; prolonged disorders of consciousness; vegetative state