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Traumatic brain injury: if the artificial coma helps
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 as a result of intentional violence on a person's head. This is often associated with an injury to the skull or brain, as happened to racing professional Michael Schuhmacher.
The seriousness of an accident caused the doctors to put the former racing driver in an artificial coma a month ago. In serious accidents, the best way to relieve the body is by artificially induced deep sleep. Those affected by a serious accident are given long-term anesthesia with the help of medication in order to eliminate pain and consciousness. An estimated 250,000 people in Germany suffer traumatic brain injury and it is believed to be the main cause of death among those under 45 years of age. The outcome of such a serious illness is unpredictable for the treating doctors, because the healing of the patient depends on many factors. The swelling caused by the accident presses on the blood vessels and the oxygen supply can only be poorly maintained as a result, which can lead to serious permanent consequential damage. Physicians see the artificial coma as the best way to relieve the patents and it is maintained for 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 Pedagogy at the University of Oldenburg. "It is only maintained if there are important reasons for this, for example because it is urgently needed to support the brain in its recovery."
"How much the brain is damaged depends on where the tissue has broken and to what extent," Claudia Spies, head of the Clinic for Anaesthesiology with focus on intensive care medicine at the Charité in Berlin, told the newspaper "Welt" for example, on the right side, there is heavy bleeding, then one can count on the fact that the capabilities of the left physical detention are limited. " Often, those suffering from a traumatic brain injury have problems with motor skills and speech. But the memory, the concentration and the speed of thinking are also affected. Occasionally personality changes were also observed.
The artificial coma also has side effects. However, the artificial coma is not only positive for the patent, because the longer it lasts, the more difficult it is to assess the injury and the complications that arise as a result. "The complication rate increases with every day that passes in an artificial coma - and this makes the prognosis less favorable for the patient," he explains. About 40 to 50 percent of patients with severe craniocerebral trauma do not survive the artificial coma. As a result of the long lying down without any movement and artificial ventilation, 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 disorders of consciousness and perception can also occur.
"The artificial coma protects the brain from too much metabolism, it is shut down, so to speak," explains Spies, who helped develop the guidelines for doctors of the German Society for Anaesthesiology and Intensive Care Medicine for treating artificial coma. "However, this means that intact cells are initially blocked and the communication behavior of the nerve cells changes - for example those that are important for concentration and memory processes. And brain cells do not want to be permanently switched off," she reports to the world .
Early stimulation of the patient improves the chances of recovery. The consequences can be mitigated by early mobilization, ideally during the coma. In order to slowly lead the patient out of the coma, the anesthetic is usually reduced piece by piece. In each case by ten percent in one day. Little by little, the patient wakes up slowly and perceives more of his surroundings. "It is difficult to estimate how long the waking-up phase lasts," explains Spies. "It depends on how stable the circulation is, how severe the pain the patient feels during the waking process and how stressful the body feels it. Any additional stress means further damage to the brain, and everyone tries to do that To avoid circumstances. "
The patients react differently in the wake-up phase. Some experience terrible nightmares or near-death experiences at night, or the returning consciousness brings pounding headaches at the same time. An exact assessment of the consequential damage is difficult and, above all, requires patience, because it is only after a few months that you can see what restrictions the patient will have to live with in the future. Traumatic brain injury can generally be divided into three levels of severity: mild (TBI grade I), moderate (TBI grade II) and severe (TBI grade III). Colloquially, such a disease is also referred to by doctors as "concussion", "brain contusion", or "brain crushing". (fr)
Image: Dieter Schütz / pixelio.de