Intensive Care Medicine | Published: 15 December 2025
Abstract
Disorders of consciousness (DoC) represent a spectrum of
clinical conditions, including coma, unresponsive wakefulness syndrome, and the
minimally conscious state, which may result from structural and non-structural
brain injuries due to trauma, stroke, anoxia, infections of the brain, and
other causes. Clinical management of patients with DoC is especially
challenging in the critical care environment, where the level of consciousness,
a key factor in determining the trajectory of recovery, may be obscured by
sedation, analgesia, and other confounders. The 2025 International Symposium on
Intensive Care and Emergency Medicine hosted a Roundtable of 18 expert
clinicians and researchers to synthesise and discuss the latest evidence on
acute DoC epidemiology, diagnosis, treatment, and prognosis. Here, we summarise
the output of the Roundtable in the format of a roadmap with six steps related
to identifying patients with DoC, assessing for and treating confounders,
establishing a diagnosis and prognosis, selecting interventions, and
effectively communicating with family. This roadmap provides practical,
evidence-informed guidance to help intensivists navigate diagnosis, treatment,
and prognostication in patients with acute DoC. Advances in structural and
functional neuroimaging, electrophysiology, and blood-based biomarkers offer
promise for refined diagnostics and prognostication, though their clinical
translation remains limited.
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