An artificial coma puts the patient in a state of loss of consciousness via medication so that he does not suffer. It can be used in case of cardiac arrest for example. What are the different stages? What is the difference with a coma? And the risks of sequelae?
Definition: what is an artificial coma?
The French Society of Anaesthesia-Intensive Care (SFAR) defines artificial coma as “the use of medicinal means intended to ensure the physical and psychological comfort of the patient, and to facilitate treatment techniques“. It is mainly used in the services of resuscitation and by the doctors of the Samu where it allows the patient not to suffer and not be aware of what is happening for a period of time. It is usually induced by a cocktail of hypnotizers, morphine or curare and sometimes includes the establishment of a therapeutic hypothermia. It is a question of lowering the body temperature (generally at 37 degrees) between 32 and 34 degrees to rest certain vital functions such as the brain and to avoid the appearance of certain irreversible sequelae.
What is the difference between a coma and an artificial coma?
Unlike a coma induced by head trauma for example, in the case of an artificial coma, this state of loss of consciousness is caused only on medical prescription through certain intravenous hypnotics and sedatives. People kept in an induced coma are intubated to maintain respiratory support : the machine takes over from the lungs.
How long can you stay in an artificial coma?
The duration of the artificial coma is very variable: from a few hours to several weeks. It is the care that determines its duration, which doctors strive to make as short as possible.
Why put a patient in an artificial coma?
The medical team decides the establishment of an artificial coma or its therapeutic maintenance after a coma that has arisen spontaneously to avoid a return to a state of consciousness that is too early. An artificial coma can also be instituted for anesthetic purposes to reduce painful sensations during the treatment phase. As under the effect of anesthesia, the artificial coma makes it possible to rest vital functions by preventing them from drawing too much on energy reserves in order to help the body in its healing process against the trauma suffered, or cardiovascular dysfunctions. The artificial coma is a treatment indicated in different situations:
- in case of’cerebral edema risk of causing intracranial hypertension,
- ofmyocardial infarction or cardiac arrest,
- ofaccident with multiple fractures,
- of septic shock,
- of pneumonia,
- ofstroke,
- of trauma severe craniocerebral.
What are the different stages of coma?
As with cases of coma, the evaluation of artificial coma is based on a specific scale, theGlasgow scalerated from 3 to 15. Three criteria are decisive : eye opening, verbal response and motor response. The higher the score, the shallower the coma. A score of 3 thus signifies the total absence of responses. A score of 15, a normal, spontaneous and voluntary response to the tests. The patient has his eyes closed, he is unable to react to external stimuli (including pain) and he is unable to be roused.
What are the risks of sequelae after an artificial coma?
The longer the artificial coma lasts, the greater the risk of infectious complications, mainly in the lungs due to artificial respiration (nosocomial infection). Prolonged bed rest can also increase the risk of muscle wasting and pressure sores for which prevention must be carried out by the medical team (anti-decubitus mattress, hydration, diet, mobilization, etc.). The other risks are mainly related to the indication for which the artificial coma was decided: neurological, infectious, cardiac consequences…
When the vital constants of a patient plunged into an artificial coma return to normal, doctors gradually begin to reduce the administration of sedatives and raise body temperature. The recovery phase is closely monitored and a rehabilitation is sometimes implemented to compensate for muscle loss, eating difficulties, and the resumption of independent breathing. It’s also the time toassess the consequences neurological, cardiac, dermatological or pulmonary.
- French Society of Anesthesia-Intensive Care (SFAR)