Approach to the comatose patient

Background: Coma is a medical emergency and may constitute a diagnostic and therapeutic challenge for the intensivist. Objective: To review currently available data on the etiology, diagnosis, and outcome of coma. To propose an evidence-based approach for the clinical management of the comatose patient. Data Source: Search of Medline and Cochrane databases; manual review of bibliographies from selected articles and monographs. Data Synthesis and Conclusions: Coma and other states of impaired consciousness are signs of extensive dysfunction or injury involving the brainstem, diencephalon, or cerebral cortex and are associated with a substantial risk of death and disability. Management of impaired consciousness includes prompt stabilization of vital physiologic functions to prevent secondary neurologic injury, etiological diagnosis, and the institution of brain-directed therapeutic or preventive measures. Neurologic prognosis is determined by the underlying etiology and may be predicted by the combination of clinical signs and electrophysiological tests.