Traumatic brain injury This is how the artificial coma ends

Traumatic brain injury: When the artificial coma helps

01/29/2014

In most cases, a so-called traumatic brain injury occurs as a result of sports, work or household accidents. In rare cases, trauma can also occur through intentional trauma to the head of a person. This is often associated with injury to the skull or brain, as happened to racing professional Michael Schuhmacher.

The severity of an accident caused the doctors a month ago to put the former racer in an artificial coma. In severe accidents, it is the best way to relieve the body through the artificially induced deep sleep. People affected by a serious accident are put on long-term anesthetics with medication to eliminate pain and consciousness. An estimated 250,000 people in Germany suffer a traumatic brain injury and it should be the main cause of death among the under-45s. For the treating physicians, the outcome of such a serious illness is unpredictable, as the healing of patients depends on many factors. The swelling caused by the accident presses on the blood vessels and the oxygen supply can be maintained only poorly, which can lead to serious lasting damage. The physicians see in the artificial coma, the best way to relieve the patents and it will be maintained as long as possible.

"The medical goal is always to end the artificial coma as soon as possible," says Andreas Zieger from the Institute for Special and Rehabilitation Education at the University of Oldenburg. "It will only be sustained if there are important reasons, for example because it is urgently needed to help the brain recover."

"How much the brain is damaged depends on where tissue has broken and to what extent," says Claudia Spies, head of the Department of Anesthesiology with a focus on surgical intensive care at the Charité in Berlin, told the newspaper „world“ "If there was a heavy hemorrhage on the right side, then you can expect that the abilities of the left body are limited." Frequently, those affected with craniocerebral trauma have problems with motor skills and speech. But also the memory, the concentration and the speed of thinking are affected. From time to time, personality changes were also observed.

The artificial coma also has side effects
But the artificial coma is not only positive for the patents to evaluate, because the longer it lasts, the heavier the injury is to assess and the subsequent complications occurring. "Every day that passes in an artificial coma, the complication rate increases - and thus the prognosis for the patient unfavorable," he explains. About 40 to 50 percent of patients with severe craniocerebral trauma do not survive the artificial coma ... Due to the long lying without any movement and the artificial respiration, thrombosis can occur or the patient suffers from pneumonia. In the long term, a weakening of the immune system, a blood pressure regulation disorder, nerve and muscle weakness or long-lasting disturbances of consciousness and perception may occur.

"The artificial coma protects the brain from too much metabolism, it is shut down in a sense," said Spies, which has developed the doctors guide of the German Society of Anaesthesiology and Intensive Care Medicine for the treatment of artificial coma. "However, this means that intact cells are initially blocked and the communication behavior of nerve cells changes - such as those that are important for concentration and memory processes, and brain cells do not want to be shut down permanently," she reports to the world.

Early stimulation of the patients improves the chances of recovery
The consequences can be mitigated by early mobilization, preferably even during the coma. To slowly lead the patient out of the coma, the anesthetic is usually reduced bit by bit. In each case by ten percent in one day. Gradually, the patient wakes up slowly and becomes more aware of his surroundings. "It's difficult to estimate how long the wake-up phase takes," explains Spies. "It depends on how stable the circulatory system is, how severe the pain the patient feels during the recovery process, and how stressful the body feels it is." Every additional stress means further damage to the brain, and that's what you're trying to do Avoid circumstances. "

The patients react differently in the recovery phase. Some go through terrible nightmares or near-death experiences at night or the returning consciousness brings at the same time hammering headache. Accurate assessment of the consequential damage is difficult and, above all, requires patience, because only after a few months can one recognize the limitations the patient must live with in the future. In general, traumatic brain injury can be divided into three degrees of severity: mild (SHT grade I), moderate (SHT grade II) and severe (SHT grade III). Colloquially, such a disease by the medical profession as well „concussion“, „brain contusion“, or as „brain contusion“ designated. (Fr)