ArticleThe Journal of head trauma rehabilitation
Assessment of Covert Consciousness in the Intensive Care Unit: Clinical and Ethical Considerations.
Article in The Journal of head trauma rehabilitation. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed, 70 citations in OpenAlex.
- From fMRI to Family Meeting: Clinician and Family Perspectives on Neurotechnology-Informed Shared Decision-Making in Disorders of Consciousness.Neurocritical care · 2026Article
- Updates in Management of Acute Disorders of Consciousness After Traumatic Injury.Brain sciences · 2026Review
- Temporal network instability and low-frequency overconnectivity underlie disorders of consciousness in severe brain injury.Scientific reports · 2025Article
- Palliative General Anesthesia at Terminal Extubation: "Go Gentle into that Good Night".Neurocritical care · 2025Article
- EEG Response to Sedation Interruption Complements Behavioral Assessment After Severe Brain Injury.Annals of clinical and translational neurology · 2025Article
- Predictors of Recovering Full Consciousness: Results From a Prospective Multisite Italian Study.European journal of neurology · 2025Observational
- Care of the Patient Nearing the End of Life in the Neurointensive Care Unit.Neurocritical care · 2024Review
- Disclosing Results of Tests for Covert Consciousness: A Framework for Ethical Translation.Neurocritical care · 2024Review
- Disorders of Consciousness Rehabilitation: Ethical Dimensions and Epistemic Dilemmas.Physical medicine and rehabilitation clinics of North America · 2024Review
- Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Neuroimaging.Neurocritical care · 2023Article
- Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, treatment, and long-term outcomes.Critical care (London, England) · 2023Review
- Challenges to Brain Death in Revising the Uniform Determination of Death Act: The UDDA Revision Series.Neurology · 2023Article
- Measuring Consciousness in the Intensive Care Unit.Neurocritical care · 2023Article
- Multimodal Neuromonitoring and Neurocritical Care in Swine to Enhance Translational Relevance in Brain Trauma Research.Biomedicines · 2023Article
- End-Of-Life Care in the Potential Donor after Circulatory Death: A Systematic Review.The Neurohospitalist · 2023Review
- Neuroprognostication: a conceptual framework.Nature reviews. Neurology · 2022Review
- Conventional and Investigational Approaches Leveraging Clinical EEG for Prognosis in Acute Disorders of Consciousness.Seminars in neurology · 2022Review
- Early Rehabilitation for Patients with Disorders of Consciousness after Severe COVID-19.Neurocritical care · 2022Article
- Ethical Considerations in Clinical Trials for Disorders of Consciousness.Brain sciences · 2022Article
- Psychophysiological Effects of Biographical Interventions in People With Unresponsive Wakefulness Syndrome and Minimally Conscious State.Frontiers in neurology · 2022Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo propose a practical ethical framework for how task-based functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) may be used in the intensive care unit (ICU) to identify covert consciousness in patients with acute severe traumatic brain injury (TBI).
methodsWe present 2 clinical scenarios in which investigational task-based fMRI and EEG were performed in critically ill patients with acute severe TBI who appeared unconscious on the bedside behavioral assessment. From these cases, we consider the clinical and ethical challenges that emerge and suggest how to reconcile them. We also provide recommendations regarding communication with families about ICU patients with covert consciousness.
resultsCovert consciousness was detected acutely in a patient who died in the ICU due to withdrawal of life-sustaining therapy, whereas covert consciousness was not detected in a patient who subsequently recovered consciousness, communication, and functional independence. These cases raise ethical challenges about how assessment of covert consciousness in the ICU might inform treatment decisions, prognostication, and perceptions about the benefits and burdens of ongoing care.
conclusionsGiven that covert consciousness can be detected acutely in the ICU, we recommend that clinicians reconsider evaluative norms for ICU patients. As our clinical appreciation of covert consciousness evolves and its ethical import unfolds, we urge prognostic humility and transparency when clinicians communicate with families in the ICU about goals of care.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.