Coma (Comas)

A profound state of unconsciousness associated with depressed cerebral activity from which the individual cannot be aroused. Coma generally occurs when there is dysfunction or injury involving both cerebral hemispheres or the brain stem RETICULAR FORMATION.

Also Known As:

Networked: 5753 relevant articles (166 outcomes, 298 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Hypothermia
2.	Heart Arrest (Cardiac Arrest)
3.	Seizures (Seizure)
4.	Poisoning
5.	Cerebral Malaria

Experts

1.	Oddo, Mauro: 19 articles (12/2015 - 07/2006)
2.	Rossetti, Andrea O: 17 articles (12/2015 - 11/2005)
3.	Butterworth, Roger F: 17 articles (07/2012 - 07/2002)
4.	Friberg, Hans: 15 articles (08/2015 - 04/2005)
5.	Ely, E Wesley: 15 articles (01/2015 - 04/2004)
6.	Horn, Janneke: 11 articles (08/2015 - 04/2010)
7.	Pandharipande, Pratik P: 10 articles (10/2014 - 12/2007)
8.	Girard, Timothy D: 10 articles (10/2014 - 01/2007)
9.	Laureys, Steven: 10 articles (02/2014 - 01/2005)
10.	Alió, Jorge L: 10 articles (08/2013 - 10/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Coma:

1.	barbituric acid (barbiturate)IBA 10/01/2005 - "Monitoring for a therapeutic level of barbiturate coma includes targeting drug levels and using continuous electroencephalogram monitoring, considered the gold standard. " 11/01/1997 - "EEG and EP can provide an early indication of clinically relevant change due to evolving disease or in response to therapy, which is especially helpful when the neurologic examination is limited due to severe coma, therapeutic barbiturate coma, or neuromuscular blockade. " 02/01/1984 - "Although this study did not establish the possible effectiveness of barbiturate coma in improving residual neurologic damage after TCI, the data do demonstrate that any possible effectiveness in this model is not associated with any improvement in the markedly decreased cerebral perfusion after TCI." 10/22/2012 - "Several neuroprotective strategies such as barbiturate coma and hypothermic therapies have been promising in experimental studies but had limited efficacies in clinical trials. " 05/01/1992 - "This study reports all complications and side effects occurring in 38 patients with severe traumatic brain lesions treated with barbiturate coma because of a dangerous increase in intracranial pressure. "
2.	AmmoniaIBA 09/01/1998 - "The results showed that survival as well as porcine hepatocyte integrity improved, the onset of coma delayed, and the ammonia levels decreased in LIS rats of the 38 hour group compared to the 14 hour group, but no statistically significant differences were observed. " 06/01/1989 - "Studies of ammonia loading: effects of rate of delivery and enhanced removal of NH4 on blood levels of ammonia and coma induction." 01/01/1981 - "Previous studies have implicated the ascending reticular activating system (RAS) as playing a vital role in ammonia induced coma. " 06/01/2015 - "IHA is characterized by a sudden increase in plasma ammonia levels in the absence of any identifiable causes, which mostly results in intractable coma and high mortality. " 08/15/2013 - "The main prognostic factors are, irrespective of the underlying cause, the duration of the hyperammonemic coma and the extent of ammonia accumulation. "
3.	BenzodiazepinesIBA 02/01/1991 - "This might be particularly useful because there is nothing about benzodiazepine-induced coma that clearly distinguishes it from other causes of coma; thus, there are no signs or symptoms that may reasonably allow benzodiazepine overdose to be confirmed or eliminated on clinical grounds. " 01/01/1985 - "Electrophysiological and benzodiazepine binding studies demonstrated that this treatment can temporarily counteract some of the neurological disturbances of the earlier stage of coma and act as antidote of the sedative-induced episodes of coma." 06/01/2009 - "It is widely used as an antidote in comatose patients suspected of having ingested a benzodiazepine overdose. " 02/01/2009 - "These include (1) updating the definition of SE to make it more clinically relevant, (2) consideration of faster ways to initiate first-line benzodiazepine therapy in the prehospital environment, (3) moving to second-line agents more quickly in refractory status in the emergency department, and (4) increasing detection and treatment of unrecognized nonconvulsive SE in comatose neurologic emergency patients." 07/01/2008 - "When benzodiazepines are consumed jointly with alcohol or other drugs they can lead to coma or death. "
4.	Flumazenil (Romazicon)FDA LinkGeneric 01/01/2002 - "Flumazenil bolus administration was associated with an improvement in Glasgow Coma Score from 7 +/- 1 to 13 +/- 1 in the nonintubatedpatients, and from 5 +/- 1 to 11 +/- in the intubated patients. " 01/01/1994 - "There are a few case reports which suggest that flumazenil can be used as a diagnostic tool in coma of unknown aetiology but no large scale studies have proved its efficacy and cost-effectiveness. " 03/01/1988 - "This study supports the introduction of Ro 15-1788 as a useful antidote in the diagnosis and the treatment of drug-induced coma." 02/01/2007 - "Coma cocktail: a role for flumazenil?" 05/01/2004 - "To our knowledge, this is the first case in children where flumazenil has been reported to reverse antihistamine-induced coma."
5.	Insulin (Novolin)FDA Link 01/01/1984 - "This method makes it possible to utilize the advantages of insulin comatose treatment (a more marked arresting antipsychotic action and the remission persistence). " 01/01/1980 - "These data indicate that low-dose insulin therapy in severely ill comatose patients is as effective as high-dose." 11/02/1945 - "Insulin, when administered in exceptionally large doses, tends to cause improvement in both the clinical and chemical state of comatose rats." 01/01/2014 - "This study analyses the impact of TH on metabolism, including the evolution of insulin sensitivity (SI) and its variability, in patients with coma after OHCA. " 01/01/1984 - "A study of a new regimen of insulin comatose therapy by intravenous instillation has shown the feasibility of determining the minimal comatose dose of insulin and achieving the comatose state in the first days of insulin therapy. "
6.	Midazolam (Versed)FDA LinkGeneric 06/01/1991 - "Efficacy of antagonism of midazolam was assessed by times to eye opening and self identification, modified Steward coma scale, a post-box toy completion-time ratio and qualitatively by an independent observer. " 11/01/2008 - "Reduced midazolam clearance must be considered in prolonged coma." 03/01/2002 - "At age 5 months, electroencephalograms (EEGs) showed continuous generalized slow spike-waves, predominantly in the right temporal region; however, EEGs normalized after induction of coma with intravenous midazolam. " 08/01/1999 - "The limit of quantification (0.1 mg/L) is much lower than concentrations found in patients with a coma caused by the accumulation of 1-OH midazolam glucuronide. " 08/01/1999 - "In recent years, it has become clear that the presence of high concentrations of 1-OH midazolam glucuronide is probably the cause of unexplained prolonged midazolam comas in patients with poor renal function. "
7.	Glucose (Dextrose)FDA LinkGeneric 01/01/1982 - "We conclude that enhanced endogenous glucose production and reduced renal clearance of glucose may contribute to precipitate hyperosmolar non-ketotic coma. " 10/01/2010 - "Additionally, covariance analysis was performed to identify regions where decreased changes in regional cerebral glucose metabolism significantly correlated with a decrease of level of consciousness measured by JFK-coma recovery scale. " 06/01/2010 - "Four variables within the hierarchical log linear model (age, raised serum glucose, low haemoglobin, Glasgow Coma Score) had a direct independent statistical relationship with outcome. " 02/01/2010 - "Compared with others, underweight patients had on admission a lower Glasgow coma score (P = 0.0006) and cerebrospinal fluid glucose concentration (P = 0.03), and a slower capillary filling time (P = 0.02). " 11/01/2009 - "Quantitative assessment of the abnormalities of hyperosmolar coma when glucose excess is larger than Na deficit."
8.	BilirubinIBA 07/01/1988 - "Initiation of EBPT was instituted according to the criteria of either a serum bilirubin greater than 15 mg/dl or Grade 2 or more coma. " 08/01/1982 - "The cirrhotic patients had been hospitalized for a mean of 14.5 +/- 1.9 days before therapy, had a mean bilirubin of 13 mg/100 ml, and had been in coma for 4.8 +/- 0.7 days despite standard therapy. " 11/01/1969 - "Dialysis in four patients had no effect on the coma; the addition of albumin to the dialysate did not increase the extraction of bilirubin. " 05/01/2013 - "Those patients with early coma grade who were treated with NAC showed significant improvement in bilirubin and ALT levels when compared to the other three groups (maximum p < 0.02 for NAC 1-2 vs. the 3 other treatments) when predicting death or transplantation. " 07/01/1993 - "Key factors in determining initiation, efficacy, and cessation of plasmapheresis were coma grade (II-III), total bilirubin levels, and the activities of coagulation tests. "
9.	OxygenIBA 03/01/1990 - "His coma resolved completely after the administration of the double-blind study drug, obviating treatment with hyperbaric oxygen. " 09/01/1979 - "Cerebral metabolic studies in hyperemic patients yielded a very low oxygen uptake and arteriovenous oxygen difference, indicating that the high blood flow was a true "luxury perfusion." When instances of presumed luxury perfusion were excluded, CBF was positively correlated with level of consciousness, assessed on a four-point coma scale." 10/29/2015 - "Molecular oxygen (O2), however, despite its detection on other icy bodies such as the moons of Jupiter and Saturn, has remained undetected in cometary comas. " 10/29/2015 - "Abundant molecular oxygen in the coma of comet 67P/Churyumov-Gerasimenko." 01/01/2015 - "The final adjusted model for the prediction of postdischarge mortality included the variables mid-upper arm circumference (OR 0.95, 95% CI 0.94 to 0.97, per 1 mm increase), time since last hospitalisation (OR 0.76, 95% CI 0.61 to 0.93, for each increased period of no hospitalisation), oxygen saturation (OR 0.96, 95% CI 0.93 to 0·99, per 1% increase), abnormal Blantyre Coma Scale score (OR 2.39, 95% CI 1·18 to 4.83), and HIV-positive status (OR 2.98, 95% CI 1.36 to 6.53). "
10.	Pentobarbital (Nembutal)FDA Link 08/01/1986 - "The clinical application of a computer system to research and patient care in a selected research population, the pentobarbital coma study group, is described. " 07/01/2008 - "During pentobarbital coma, electroencephalographic monitoring is used to document burst suppression (3-5 episodes of electrical activity/min). " 07/01/2008 - "Bispectral index monitoring documents burst suppression during pentobarbital coma." 04/01/2008 - "A retrospective, observational evaluation of patients (>14 y of age) who received a therapeutic pentobarbital coma in combination with EN was conducted. " 04/01/2008 - "There is considerable debate regarding the appropriateness of feeding patients by the enteral route in conjunction with pentobarbital coma therapy. "

Therapies and Procedures

1.	Resuscitation 01/01/1960 - "[A case of very grave asthmatic disease with acidosic-coma treated and cured with respiratory resuscitation]." 07/01/2005 - "Seventy percent of the seriously impaired patients never regained consciousness and non emerged from coma within five days; all of the patients with good outcome were alert within twenty hours after resuscitation. " 06/13/1981 - "In one center (Hospital for Sick Children, Toronto) the prognosis in those children who remained comatose after the initial resuscitation was significantly improved with these methods. " 09/01/1977 - "Seventy percent of the seriously impaired patients never regained consciousness and none emerged from coma within 5 days; 90 percent of patients with good outcome were alert within 18 hours after resuscitation. " 08/01/2015 - "The aim of this study was to determine whether different treatment temperatures after resuscitation affected the prognostic accuracy of clinical neurological findings and somatosensory evoked potentials (SSEP) in comatose patients. "
2.	Cardiopulmonary Resuscitation (CPR) 11/01/2014 - "Eight studies targeting patients who were comatose following CPR, treated with TH, and using SSEP as an outcome predictor are reviewed. " 01/01/2006 - "This study was conducted to identify the temperature gradient between the jugular vein and pulmonary artery in comatose patients after cardiopulmonary resuscitation. " 11/05/2005 - "In this study, we focused on the topic of how to evaluate the severity of coma after CPR. " 08/01/2004 - "This study investigated whether or not early electroencephalographic (EEG) findings and brain computed tomographic (CT) features reflect the prognosis of comatose patients for 48 h after cardiopulmonary resuscitation (CPR). " 06/01/2014 - "She received prolonged CPR (40 minutes until ROSC) and remained comatose. "
3.	Drug Therapy (Chemotherapy) 07/01/2014 - "Glascow Coma Scale scores in patients significantly improved from 11.13 ± 0.52 to 14.50 ± 0.27 after chemotherapy. " 12/01/2002 - "Despite haematological remission with chemotherapy, she developed neurological symptoms, progressing to coma. " 05/01/2001 - "Chemotherapy begun on day three decreased the percentage of infected red blood cells (RBC) from 25% to 2%, but the patient fell into coma on the same day. " 09/01/1992 - "On the 6th day after 2nd cycle chemotherapy, she was confused, and we diagnosed her as a case of hyperosmolar nonketotic coma (HNC) on the 7th day. " 07/01/1992 - "As soon as chemotherapy was begun, the patient fell into deep coma. "
4.	Aftercare (After-Treatment) 07/01/1991 - "Four of the patients recovered after treatment, but the patient admitted with neurological involvement remained comatose until her death." 02/01/2011 - "Mean higher order wavefront aberration RMS increased 0.12 μm, spherical aberration 0.09 μm, and coma 0.04 μm after treatment (6-mm diameter). " 11/01/2009 - "Average root-mean-square higher order aberrations increased 0.05 microm after treatment, mean spherical aberration increased 0.08 microm after treatment, and mean coma increased 0.04 microm after treatment (all for 6.0-mm analysis diameter). " 05/01/1997 - "The mean spherical aberration coefficient increased from 0.36 +/- 0.11 before, to 0.91 +/- 0.37 after treatment, while the mean coma-like aberration coefficient changed from 0.28 +/- 0.16 before, to 0.60 +/- 0.31 after treatment. " 10/01/1993 - "Both patients were neurologically asymptomatic prior to treatment but developed coma and multifocal neurological deficits after treatment. "
5.	Artificial Respiration (Mechanical Ventilation) 01/01/1989 - "The drug is also very useful in treatment of intoxicated patients, in differential-diagnostic procedures of coma of unknown origin, and in restoration of vigilance after prolonged sedation for mechanical ventilation. " 01/01/2007 - "Multivariable analysis identified one factor associated with less information time (room with more than one bed) and seven factors associated with more information time, including five patient-related factors (surgery on the study day, higher Logistic Organ Dysfunction score, coma, mechanical ventilation, and worsening clinical status) and two family-related factors (first contact with family and interview with the spouse). " 01/01/2015 - "The coma-recovery time, mechanical ventilation time, and healing time were lower in the experimental group than in the control group (P < 0.05), while the hospitalization expenses were higher in the experimental group than in the control group (P < 0.01); moreover, no significant difference was observed in the mortality rate between the two groups. " 06/01/2014 - "Three patients were admitted to our ICU with sudden-onset coma and respiratory and cardiovascular dysfunctions requiring endotracheal mechanical ventilation. " 03/01/2014 - "Mechanical ventilation and blood purification therapy were performed in the intensive care unit because he was in coma and his respiratory function had gradually worsened. "