title: Acute consciousness disorders in intensive care medicine - value of its grading for prognostic conclusion.
abstract: OBJECTIVE
  To understand consciousness we have to understand the mechanism of its function, which is to effectively organize sensory inputs from our environment. Consciousness is the basic, essential outcome of the process of organizing these sensory inputs, resulting in cognitive, mental, emotional, executive, instinctual or other marginally aware states. This reciprocal process of the CNS implies that organization is an act, which precedes consciousness, i.e. preconscious function. Most scientific explanations portray consciousness as an "emergent property" of classical computer-like activities in the brains neural networks. Doctors at ICU work daily with patients with altered human consciousness. Therefore, they must recognize and manage it skilfully and use adequate approaches for definite solutions.
  
  
  METHODS
  We observed a series of patients with traumatic and non traumatic brain injuries admitted to the ICU. The quality of life of these patients during the course of intensive care was very elementary and the final outcome GCS (oGCS) for future life was defined as a comatose state or apallic state, very rarely was it restored to premorbid condition as far as lucidity, attention, cognition, and executive functions.
  
  
  RESULTS
  We found that a significant oGCS increase in relation to condition at admission or intake GCS (iGCS) in the group with 184 patients total (p<0.00001), in cardio-pulmonary resuscitation (CPR), traumatic brain injury (TBI) subgroups (p<0.00001) and in spontaneous haemorrhage (SH) (p<0.05) represents the only basic prerequisite for further improvement. It is not easy to find good therapeutic approaches after traumatic and non traumatic brain injury. A statistically significant oGCS increase in relation to iGCS due to quite intense medical care and keeping disclosed the state of unconsciousness with further probable evolution through the following possible ways: death in fluent comatose state, delirium and awakening, delirium ending in death, direct awakening from comatose state. Therefore significantly increased oGCS is the only basic prerequisite for pragmatically optimal "quality of life" in the course of later life.
  
  
  CONCLUSIONS
  We raise general questions for both scientists and clinicians that will assist in their efforts to understand the basic endogenous conscious biological processes, their pathological changes and the links between them.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine and Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Armed Forces Academy of General M. R. Štefánik, Liptovský Mikuláš, Slovak Republic. saniova@jfmed.uniba.sk
authors.forename: Beata
authors.initials: B
authors.lastname: Sániová
authors.forename: Michal
authors.initials: M
authors.lastname: Drobný
authors.forename: Eva
authors.initials: E
authors.lastname: Drobná
authors.forename: Alireza
authors.initials: A
authors.lastname: Matloobi
mesh_terms: D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis*; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D003244:Consciousness Disorders / Q000150:complications / Q000175:diagnosis*; D003422:Critical Care / Q000706:statistics & numerical data*; D003693:Delirium / Q000150:complications; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018154:Slovakia