Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Persistent Vegetative State”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed1993

Patients in the persistent vegetative state: problems in their long term management.

Physicians responsible for the long term management of patients in the persistent vegetative state face several problems. These include deciding whether tube feeding is treatment or nutritional care, whether withdrawal of tube feeding is an appropriate form of management, what clinical advantage there is in active treatment; at what level of awareness can a patient be said to have a quality of life; and who should determine a patient's right to die. These problems are determined more by social, legal, emotional, cultural, religious, and economic forces than by clinical facts.

Brain Damage, Chronic↗
PubMed2001

Maternal persistent vegetative state with successful fetal outcome.

A woman suffered from massive blunt injuries in a motor vehicle accident at a presumed 4 weeks' gestation, but she successfully carried the fetus for an additional 29 weeks. Premature labor began at 33 weeks' gestation and a live 1,890 g male was delivered. His development was normal for the 12-months postnatal follow-up period. The patient remained in a persistent vegetative state. Only 12 cases of severely brain-injured pregnant patients who delivered babies have been reported in English literature. Such patients need special maternal and fetal monitoring. As shown in our patient, successful fetal outcome could be obtained in a mother who suffered from hypovolemic shock and diffuse axonal injury, was treated with numerous medications from 4 weeks' gestation, and survived premature labor at 33 weeks' gestation in a persistent vegetative state. This report represents the longest interval from maternal vegetative state to obstetric delivery. From our case, it would seem that no clear limit exists that restricts the physician's ability to support a severely injured pregnant patient.

Adult↗
PubMed1996

Euthanasia and persistent vegetative state individuals: the role and moral status of autonomy.

This paper offers a philosophical consideration and evaluation of several different criteria of moral standing, and discusses their implications for persistent vegetative state (PVS) individuals who were once competent. It is argued that the only criterion PVS individuals meet is that of being human, which is not the best test of moral standing. Accordingly it is, in principle, morally acceptable to perform passive or active euthanasia on PVS individuals or to use their bodies for research or for organ harvest. Nevertheless, the autonomous choices made by the persons the PVS individuals used to be can still impose moral obligations. Indeed, it is argued that the capacity for autonomy is a particularly appealing criterion of moral standing, and that the implications of this standard for PVS individuals confirm that appeal.

Advance Directive Adherence↗
PubMed1997

The persistent vegetative state and anencephaly: problematic paradigms for discussing futility and rationing.

Medical futility has been a controversial issue for the last several years. Although anencephalic infants and patients in the persistent vegetative state (PVS) have often been suggested as paradigmatic cases for discussing the issue of medical futility, there is no consensus among physicians or ethicists that treatment of such patients is futile and courts have not supported the futility argument. Focusing on the issue of medical futility will not resolve the management issues surrounding the care of patients in PVS or anencephalic infants. Instead, an analysis of the benefits and burdens of treatments offers a potential solution by demonstrating that the real problem is the dissociation of the benefits and burdens of treatment for such patients. We propose the idea that anencephalic infants and patients in PVS provide an appropriate paradigm for discussing the issue of rationing of health-care resources.

Anencephaly↗
PubMed2002

Acetazolamide vasoreactivity in vascular dementia and persistent vegetative state evaluated by transcranial harmonic perfusion imaging and Doppler sonography.

To clarify the pathophysiological differences of the cerebrovascular reserve capacity in relation to cerebral cognitive impairments between vascular dementia (VaD) and persistent vegetative state (PVS), we evaluated acetazolamide (ACZ) vasoreactivity testing by transcranial harmonic perfusion imaging (HPI) and Doppler sonography (TCD). Sixteen patients (age: 29-85 years; mean: 62) were divided into three groups: 7 VaD, 4 PVS, and 5 nondementia patients. Mean velocity (Vm) in the middle and posterior cerebral artery (MCA, PCA) was measured, and time-intensity curves of the HPI were evaluated at three regions of interest-the bilateral temporal lobe (TL), basal ganglia (BG), and thalamus (Th). TCD and HPI were evaluated before (resting state) and after ACZ administration, and vasoreactivity was compared among the three groups in terms of resting values and relative changes (%Delta) of Vm, peak intensity (PI), area under curve (AUC), and mean transit time (MTT). Results of the resting state: Decreased Vm, PI, and AUC of the VaD and PVS groups were more obvious in the right side. Results of vasoreactivity: In the PVS group, %DeltaVm decreased in the left PCA and MCA; %DeltaPI and %DeltaAUC decreased in the left TL and bilateral BG. In the VaD group, %DeltaPI and %DeltaAUC decreased in the right TL; %DeltaMTT tended to increase in the left side. ACZ vasoreactivity tests by transcranial HPI and TCD allowed bedside, noninvasive quantitative evaluation of the pathophysiology of cognitive function impairment in relation to cerebrovascular reserve capacity in VaD and PVS.

Acetazolamide↗
PubMedDate not supplied

[Ethical questions in the treatment of the person in persistent vegetative state. The symbolic case of Nancy Beth Cruzan].

The article deals with a the ethical issues about treatment of Persistent Vegetative State (Pvs) patients. The Nancy Beth Cruzan case, the US woman who died after the withdrawal of tube feeding and hydration after seven years of Pvs is analysed as paradigmatic case. The ethical analysis face with the following issues: 1. Is the Pvs synonymous of cerebral death?; 2. How the tube feeding and hydration must be considered: ordinary or extraordinary, proportionate or disproportionate means? 3. The issue of the living will; 4. the economic impact of the management of the Pvs patients. The conclusion of the contribution is the following: the withdrawal of the artificial feeding and hydration of a Pvs patient must be considered as omissive euthanasia, and consequently it is an action ethically unacceptable, in the light of the Hippocratic medical tradition and of the person-centred ethics.

Adult↗
PubMed2003

Acetazolamide vasoreactivity in persistent vegetative state and vascular dementia evaluated by transcranial harmonic perfusion imaging and Doppler sonography.

UNLABELLED: To clarify the pathophysiological differences of the cerebrovascular reserve capacity in relation to cerebral cognitive impairments between persistent vegetative state (PVS) and vascular dementia (VD), we evaluated acetazolamide (ACZ) vasoreactivity testing by transcranial harmonic perfusion imaging (HPI) and Doppler sonography (TCD). METHODS: The subjects were 11 adult patients with severe cognitive impairments (4 PVS, 7 VD). TCD mean velocity (Vm) in the middle and posterior cerebral artery (MCA, PCA) and peak intensity (PI), area under curve (AUC), and mean transit time (MTT) analyzed by HPI time-intensity curves in the bilateral temporal lobe (TL), basal ganglia (BG), and thalamus (Th) were evaluated before and after ACZ administration. Resting values and relative changes (%delta) of TCD and HPI parameters were compared between PVS and VD. RESULTS: a) Resting values: There were no significant differences between the two groups. b) Vasoreactivity: 1) PVS: %delta Vm decreased in the left PCA and MCA. %delta PI/AUC/MTT decreased in the left TL and bilateral BG. 2) VD: %delta PI/AUC decreased in the right TL. %delta MTT tended to decrease in the right side. CONCLUSION: ACZ vasoreactivity tests by transcranial HPI and TCD allowed bedside, non-invasive, quantitative evaluation of the pathophysiology of cognitive function impairment and treatments, in relation to cerebrovascular reserve capacity in PVS and VD.

Acetazolamide↗
PubMed2003

Effects of musicokinetic therapy and spinal cord stimulation on patients in a persistent vegetative state.

We developed a method of musicokinetic therapy (MKT), employing a trampoline with live music performance (saxophone or electric piano), in an attempt to improve the clinical condition of patients in a persistent vegetative state (PVS). As an initial step for assessing the effect of MKT on PVS. we analyzed the changes in PVS score (range: 0-30) after MKT, which was continued for 3 months, in a consecutive series of 26 patients. These patients fulfilled the definition of PVS adopted by the Multi-Society Task Force on PVS. In this series, 7 patients were being treated by spinal cord stimulation at the same time. We, therefore, also had an opportunity to examine the effect of spinal cord stimulation on PVS. A greater or lesser improvement in PVS score (post-MKT score - pre-MKT score, mean +/- SD: 8.27 +/- 5.52) was observed in all patients except one. Among 12 patients who had been in PVS for 1 year or more before the initiation of MKT, 7 patients (56.3%) demonstrated improvement of their PVS score by 5 or more, and 4 patients (33.3%) reached a post-MKT score of greater than 20. The condition defined as PVS can never be scored better than 20. Since it is commonly felt that spontaneous improvement rarely occurs if PVS has continued for more than 6 months, the improvement after MKT appears to be better than that which could be observed spontaneously. The improvement in PVS score was often noted in patients with brain damage caused by trauma or SAH. There was no significant difference in improvement of the PVS score between patients who were treated by spinal cord stimulation and those who were not. Although the present study did not directly prove an effect of MKT on PVS, because no controls were involved, the results were consistent with the hypothesis that MKT is useful for improving the clinical condition of patients in PVS, especially those with severe brain damage caused by trauma or SAH.

Adolescent↗
PubMed1985

Persistent vegetative state. Review and report of electrodiagnostic studies in eight cases.

Of 81 comatose patients studied for two years, eight entered the persistent vegetative state (PVS), of whom four died and four survived. Clinically, all eight showed characteristic findings of wakefulness without cognitive function. Electrodiagnostic studies were characterized by (1) electroencephalograms that showed a range of patterns that were unchanged from the comatose through the vegetative state, (2) normal brainstem auditory evoked responses, (3) median somatosensory evoked responses that showed prolonged central conduction time, and (4) diminishing amplitude of the N20 response. These features may serve for identifying and monitoring patients in the PVS with a view to accurately predicting outcome.

Adult↗
PubMed1988

[Clinicophysiological study of multimodality evoked potentials and computed tomographic findings in persistent vegetative state].

The auditory brainstem response (ABR), short latency somatosensory evoked potential (SSEP) and visual evoked potential (VEP) of patients in the persistent vegetative state (PVS) are reported, and the correlations between the electrophysiological findings and the CT scan findings with the three clinical grades of the PVS (transitional, incomplete and complete vegetative syndromes) are discussed. Twenty two patients in a vegetative state caused by subarachnoid hemorrhage (3), hypertensive intracerebral hemorrhage (5), cerebral infarction (6), head injury (3), cerebral anoxia (4) and brain tumor (1). Each evoked response was evaluated for the presence or absence of abnormalities and assigned a grade ranked I to III. Briefly an evoked response was assigned a grade I, II, III if it satisfied the respective criteria of normal, moderately abnormal and severely abnormal or absent electrical activity. On the other hand CT scan findings in the PVS were evaluated for abnormal low density areas, ventricular dilatation and enlargement of the sulci and cisterns indicative of atrophy of the brain parenchyma. SSEP and VEP were better correlated with the clinical grade than ABR, and upper brainstem atrophy and abnormal low density area in CT scan findings were more valuable as an index to expresses the clinical features than ventricular dilatation. On the basis of these results, it is concluded that studies of ABR, SSEP and VEP associated with CT scan findings in the PVS could be a useful diagnostic aid to evaluate the lesions of these patients.

Adult↗
PubMed1993

Ethics consultants' recommendations for life-prolonging treatment of patients in a persistent vegetative state.

OBJECTIVE--Surprisingly little is known about the content of ethics consultants' recommendations. We chose to study this issue using hypothetical persistent vegetative state (PVS) cases. We addressed four questions: What recommendations do ethics consultants give regarding life-prolonging treatment (LPT) in PVS cases? To what degree is there consensus? What factors influence recommendations? Do recommendations conform to established guidelines? DESIGN--Questionnaire survey. Our questionnaire asked subjects what they would recommend for seven hypothetical vignettes involving a PVS patient that varied with respect to advance directives and family wishes. We also questioned subjects about demographic characteristics, ethics consultation experience, and personal preference for LPT in PVS. SUBJECTS--Attendees at an annual meeting of the Society for Bioethics Consultation (n = 154). RESULTS--The response rate was 77%. Eighty-one percent of respondents were ethics committee members and 62% were ethics consultants. There was general agreement among respondents for only one of seven vignettes: in the case of a PVS patient whose advance directive and family agree that LPT be stopped, 93% recommended stopping all LPT. Responses to other vignettes varied considerably. Although patient wishes were an important factor influencing recommendations, none of the respondents adhered invariably to the patient's advance directive. Recommendations were also influenced by family wishes, resource allocation considerations, legal constraints, and personal preference for LPT in PVS. Guidelines we examined were generally too equivocal to be useful for evaluating ethics consultants' recommendations. CONCLUSIONS--The finding of wide variability in ethics consultants' recommendations suggests a need to clarify standards for ethics consultation.

Coma↗
PubMed1994

Issues for nurses who care for patients in persistent vegetative states.

In a series of interviews, personal stress was identified as the most significant problem for neuroscience nurses who care for patients in persistent vegetative states. Other issues included inconsistent medical care, demanding physical care requirements, quality-of-life, ordinary versus extraordinary treatments, and the impact of this condition on patients' families. Some recommendations are presented that should help to alleviate some of these concerns.

Attitude of Health Personnel↗
PubMedDate not supplied

Persistent vegetative state: which sensory-motor variables should the physiotherapist measure?

This study used a modified Delphi technique to establish a list of core items which should be included in the measurement, by the physical therapist, of sensory-motor capacities of persons in a persistent vegetative state. Twenty-eight physical therapists with a mean of 5.9 years of experience working with this clientele participated in the study and identified 105 items as being important in the evaluation of the PVS patient (Round I). The study planning committee reduced these to 20 categories and asked the therapists to rate each category of items (a 5-point scale) as to it's importance (Round II). Physiotherapists identified 14 variables as being 'extremely' or 'very important' to include in such an evaluation. These included: tonus, voluntary movement on request, postural reactions, passive range of motion, tolerance to verticalization and postural status. These results are being used to develop a quantitative assessment instrument to be used by the physical therapist working with the PVS patient.

Arousal↗
PubMedDate not supplied

[Persistent vegetative state. Paradigm of current discussion on alterations of consciousness].

INTRODUCTION: The vegetative state is the current paradigm of discussions about the alterations of conscience. DEVELOPMENT: Although accepted by most investigators, it is still controversial. The dilemma starts with the denomination itself. In this paper we propose the denomination persistent vegetative state . We start with a historical review of the integration of consciousness. We also give epidemiological data and point out the clinical features, complementary tests and anatomical findings. The patients are classified into three grades for prognosis. Grade III includes those with the worst prognosis, who have no sleep waking cycles with or without opening their eyes. This section emphasises cases of prolonged survival and of late recovery who made almost complete recovery of their intellectual functions. We state that treatment is based on two aspects: treatment of the underlying disease and general measures and emphasise the need for a multidisciplinary team. From the bio ethical point of view, it should be remembered that the patients are alive and cannot be considered in the same group as the brain dead, in whom all encephalic function has been lost. CONCLUSIONS: It is not ethical to decide to suspend medical treatment when it is known that there is a possibility of recovery of the structural anatomy and function. We are morally obliged to maintain qualified medical attention. It has been shown scientifically that we not only should, but can, obtain the recovery of these patients, in spite of the serious damage suffered by their nervous system

Brain↗
PubMed1998

Evaluation of hypothalamic-pituitary-adrenocortical hormones and inflammatory cytokines in patients with persistent vegetative state.

Hypothalamic-pituitary-adrenocortical hormones, i.e. prolactin (PRL), human growth hormone (hGH), thyroid stimulating hormone (TSH), and Cortisol and plasma levels of cytokines, i.e. tumor necrosis factor-alpha (TNF-alpha), interleukin 1 beta (IL-1 beta), and interleukin-6 (IL-6), were assessed in 27 patients with persistent vegetative state (PVS) and in 16 outcome patients. In comparison with normal parameters, plasma levels of TSH were not significantly altered, while elevated basal hGH concentrations in 48.1% of PVS subjects and depressed cortisol levels in all PVS individuals and in patients who emerged from coma (outcome patients), respectively, were observed. In addition, higher TNF-alpha plasma levels in PVS subjects than in outcome patients and in healthy donors were found, while IL-1 beta plasma levels were elevated in both groups of patients in comparison with healthy controls. Of interest, in 55% PVS male patients hyperprolactinemia was observed, whereas in outcome patients more than six months these values were within normal range. In four patients, who emerged from coma in the course of this study, prolactin plasma levels were followed-up and increased basal values progressively fell to normal range within six months.

Adolescent↗
PubMed2006

Tube feedings and persistent vegetative state patients: ordinary or extraordinary means?

This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as a matter of conscience. Rather than providing clarification, I argue that the papal allocution has raised many difficult questions. People in situations where decisions must be made about withdrawal or continued ANH are in need of guidance. Moreover, additional analysis is needed to determine whether the papal allocution is in conflict with the traditional Catholic medical ethics understanding of the ordinary-extraordinary care distinction.

Catholicism↗
PubMed1993

Recovery of patients after four months or more in the persistent vegetative state.

A retrospective review was made of the case notes of 43 consecutive patients admitted to a unit specialising in the rehabilitation of people in the persistent vegetative state. Eleven of these patients regained awareness four months or more after suffering brain damage. The time to the first reported incidence of eye tracking was between four months and three years, and the time to the first response to command was between four and 12 months. Only one patient was eventually unable to communicate, six could use non-verbal methods of indicating at least a yes or no response, and four were able to speak. Six patients remained totally dependent while two became independent in daily activities. Four patients became independent in feeding, three required help, and four remained on gastrostomy feeding. Thus some patients can regain awareness after more than four months in a vegetative state, and, although few reach full independence, most can achieve an improved quality of life within the limitations of their disabilities. The recovery period is prolonged and may continue for several years. Even patients with profound brain damage should be offered the opportunity of a specialist rehabilitation programme.

Activities of Daily Living↗