Brian L. Edlow, MD

Detecting Covert Consciousness in the Intensive Care Unit

Severe brain injury affects more than one million people worldwide each year.

Early recovery of consciousness is a key milestone that predicts long-term recovery. Fifteen to 20% of patients with severe brain injury in the intensive care unit (ICU) may be covertly conscious, with higher levels of consciousness than their bedside behavioral examination suggests.

Without reliable tools to detect consciousness in the ICU, clinicians and families may prematurely withdraw life-sustaining therapy, which is the cause of death for up to 80% of patients with acute severe brain injuries.

Thus, it is essential that new tools are developed to detect covert consciousness and provide families with an accurate picture of their loved ones’ chances of functional recovery.

I am leading a multidisciplinary team that will optimize and implement a novel technique—transcranial magnetic stimulation electroencephalography (TMS-EEG)—in the ICU to detect consciousness and predict recovery in patients with severe brain injuries.

TMS-EEG has shown unparalleled accuracy at detecting consciousness in patients with chronic brain injuries, providing a compelling clinical and ethical rationale for translating TMS-EEG to the ICU.

This project has the potential to save lives by detecting signs of covert consciousness and preventing premature withdrawal of life-sustaining therapy in the ICU.