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links article talk english read edit view history tools tools move to sidebar hide actions read edit view history general what links here related changes upload file permanent link page information cite this page get shortened url switch to legacy parser print export download as pdf printable version in other projects wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia medical procedure medical intervention induced coma other names medically induced coma specialty neurology critical care medicine an induced coma also known as a medically induced coma mic barbiturate induced coma or drug induced coma is a temporary coma a deep state of unconsciousness brought on by a controlled dose of an anesthetic drug often a barbiturate such as pentobarbital or thiopental other intravenous anesthetic drugs such as midazolam or propofol may be used 1 2 drug induced comas are used to protect the brain during major neurosurgery as a last line of treatment in certain cases of status epilepticus that have not responded to other treatments 2 and in refractory intracranial hypertension following traumatic brain injury 1 induced coma usually results in significant systemic adverse effects the patient is likely to completely lose respiratory drive and require mechanical ventilation 3 gut motility is reduced 4 hypotension can complicate efforts to maintain cerebral perfusion pressure and often requires the use of vasopressor drugs 5 hypokalemia often results 6 the completely immobile patient is at increased risk of bed sores as well as infection from catheters 7 8 9 the presence of an endotracheal tube and mechanical ventilation alone are not indications of continuous sedation and coma only certain conditions such as intracranial hypertension refractory status epilepticus the inability to oxygenate with movement justify the high risks of medically induced comas 10 brain disruption from sedation can lead to an eight times 11 increased risk of the development of icu delirium this is associated with a doubled risk of mortality 12 during hospital admission for every one day of delirium there is a 10 increased risk of death 13 medically induced comas that achieve a rass level of 4 or 5 are an independent predictor of death 14 although patients are not sleeping while sedated they can experience hallucinations and delusions 15 that are often graphic and traumatizing in nature this can lead to post icu ptsd after hospital discharge patients that develop icu delirium are at 120 times greater risk of long term cognitive impairments 16 considering the high risks of medically induced comas protocols such as the abcdef bundle 17 and padis guidelines 18 have been developed to guide icu teams to avoid unnecessary sedation and comas icu teams that master these protocols to keep patients as awake and mobile as possible are called awake and walking icus these are teams that only implement medically induced comas when the possible benefits of sedation outweigh the high risks during specific cases survivors of prolonged medically induced comas are at high risk of suffering from post icu syndrome 19 and may require extended physical cognitive and psychological rehabilitation theory edit barbiturates reduce the metabolic rate of brain tissue as well as the cerebral blood flow with these reductions the blood vessels in the brain narrow resulting in a shrunken brain and hence lower intracranial pressure the hope is that with the swelling relieved the pressure decreases and some or all brain damage may be averted several studies have supported this theory by showing reduced mortality when treating refractory intracranial hypertension with a barbiturate coma 20 21 22 about 60 of the glucose and oxygen used by the brain is meant for its electrical activity and the rest for all other activities such as metabolism 23 when barbiturates are given to brain injured patients for induced coma they act by reducing the electrical activity of the brain which reduces the metabolic and oxygen demand 24 their action limits oxidative damage to lipid membranes and may scavenge free radicals they also lead to reduced vasogenic edema fatty acid release and intracellular calcium release 1 the infusion dose rate of barbiturates is increased under monitoring by electroencephalography until burst suppression or cortical electrical silence isoelectric flatline is attained 25 once there is improvement in the patient s general condition the barbiturates are withdrawn gradually and the patient regains consciousness controversy exists over the benefits of using barbiturates to control intracranial hypertension some studies have found that barbiturate induced coma can reduce intracranial hypertension but does not necessarily prevent brain damage 1 furthermore the reduction in intracranial hypertension may not be sustained some randomized trials have failed to demonstrate any survival or morbidity benefit of induced coma in diverse conditions such as neurosurgical operations head trauma 26 intracranial aneurysm rupture intracranial hemorrhage ischemic stroke and status epilepticus if the patient survives cognitive impairment may also follow recovery from the coma 27 due to these risks barbiturate induced coma should be reserved for cases of refractory intracranial pressure elevation 1 see also edit insulin shock therapy traumatic brain injury references edit 1 2 3 4 5 mariano gl fink me hoffman c rosengart a 2014 intracranial pressure monitoring and management in hall jb schmidt ga kress jp eds principles of critical care 4th ed mcgraw hill isbn 978 0 07 173881 1 1 2 an j jonnalagadda d moura v purdon pl brown en westover mb 2018 variability in pharmacologically induced coma for treatment of refractory status epilepticus plos one 13 10 e0205789 bibcode 2018ploso 1305789a doi 10 1371 journal pone 0205789 pmc 6209214 pmid 30379935 gueye papa n lofaso frédéric borron stephen w mellerio françoise vicaut eric harf alain baud frédéric j january 2002 mechanism of respiratory insufficiency in pure or mixed drug induced coma involving benzodiazepines journal of toxicology clinical toxicology 40 1 35 47 doi 10 1081 clt 120002884 pmid 11990203 ladopoulos theodoros giannaki maria alexopoulou christina proklou athanasia pediaditis emmanuel kondili eumorfia 15 march 2018 gastrointestinal dysmotility in critically ill patients annals of gastroenterology in greek 31 3 crete greece university of crete medical school department of intensive care medicine 273 281 doi 10 20524 aog 2018 0250 pmc 5924849 pmid 29720852 stevens robert d nyquist paul a may 2008 types of brain dysfunction in critical illness neurologic clinics 26 2 baltimore md johns hopkins university school of medicine 469 486 doi 10 1016 j ncl 2008 02 004 issn 0733 8619 pmid 18514822 retrieved 27 august 2025 aytuluk hande gurbuz topcu hulya september 2020 severe hypokalemia and rebound hyperkalemia during barbiturate coma in patients with severe traumatic brain injury neurocirugía in spanish 31 5 elsevier ltd 216 222 doi 10 1016 j neucir 2019 12 003 hdl 11491 7170 pmid 32146086 sarah lewis pharmd 16 march 2022 han m d seunggu ed medically induced coma everything you need to know healthgrades brain nerves healthgrades marketplace llc retrieved 27 august 2025 hayashi yuichi shibata hideaki kudo takuya nishida shohei ishikawa rie moriya chie suzuki akio kimura akio inuzuka takashi 15 may 2018 drug induced pressure ulcers in a middle aged patient with early stage parkinson s disease internal medicine 57 10 gifu university graduate school of medicine 1483 1486 doi 10 2169 internalmedicine 9700 17 pmc 5995694 pmid 29279501 nseir saad makris demosthenes mathieu daniel durocher alain marquette charles hugo 15 march 2010 intensive care unit acquired infection as a side effect of sedation critical care 14 2 r30 biomed central ltd doi 10 1186 cc8907 pmc 2887136 pmid 20226064 eikermann matthias needham dale m devlin john w may 12 2023 multimodal patient centred symptom control a strategy to replace sedation in the icu pdf the lancet 11 6 506 509 doi 10 1016 s2213 2600 23 00141 8 pmid 37187192 pan yanbin yan jianlong jiang zhixia luo jianying zhang jingjing yang kaihan 2019 07 10 incidence risk factors and cumulative risk of delirium among icu patients a case control study international journal of nursing sciences 6 3 247 251 doi 10 1016 j ijnss 2019 05 008 issn 2352 0132 pmc 6722464 pmid 31508442 salluh jorge i f wang han schneider eric b nagaraja neeraja yenokyan gayane damluji abdulla serafim rodrigo b stevens robert d 2015 06 03 outcome of delirium in critically ill patients systematic review and meta analysis bmj 350 h2538 doi 10 1136 bmj h2538 issn 1756 1833 pmc 4454920 pmid 26041151 ely e wesley shintani ayumi truman brenda speroff theodore gordon sharon m harrell frank e inouye sharon k bernard gordon r dittus robert s 2004 04 14 delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit jama 291 14 1753 1762 doi 10 1001 jama 291 14 1753 issn 1538 3598 pmid 15082703 shehabi yahya bellomo rinaldo reade michael c bailey michael bass frances howe belinda mcarthur colin seppelt ian m webb steve weisbrodt leonie sedation practice in intensive care evaluation spice study investigators anzics clinical trials group 2012 10 15 early intensive care sedation predicts long term mortality in ventilated critically ill patients american journal of respiratory and critical care medicine 186 8 724 731 doi 10 1164 rccm 201203 0522oc issn 1535 4970 pmid 22859526 ali mohammed cascella marco 2023 icu delirium statpearls treasure island fl statpearls publishing pmid 32644706 retrieved 2023 08 15 girard timothy d jackson james c pandharipande pratik p pun brenda t thompson jennifer l shintani ayumi k gordon sharon m canonico angelo e dittus robert s bernard gordon r ely e wesley july 2010 delirium as a predictor of long term cognitive impairment in survivors of critical illness critical care medicine 38 7 1513 1520 doi 10 1097 ccm 0b013e3181e47be1 issn 1530 0293 pmc 3638813 pmid 20473145 pun brenda t balas michele c barnes daly mary ann thompson jennifer l aldrich j matthew barr juliana byrum diane carson shannon s devlin john w engel heidi j esbrook cheryl l hargett ken d harmon lori hielsberg christina jackson james c january 2019 caring for critically ill patients with the abcdef bundle results of the icu liberation collaborative in over 15 000 adults critical care medicine 47 1 3 14 doi 10 1097 ccm 0000000000003482 issn 1530 0293 pmc 6298815 pmid 30339549 sccm padis guidelines society of critical care medicine sccm retrieved 2023 08 15 smith sarah rahman omar 2023 post intensive care syndrome statpearls treasure island fl statpearls publishing pmid 32644390 retrieved 2023 08 15 the brain trauma foundation the american association of neurological surgeons the joint section on neurotrauma and critical care use of barbiturates in the control of intracranial hypertension journal of neurotrauma 17 6 7 mary ann liebert inc 527 530 2000 doi 10 1089 neu 2000 17 527 pmid 10937896 lee mw deppe sa sipperly me barrette rr thompson dr june 1994 the efficacy of barbiturate coma in the management of uncontrolled intracranial hypertension following neurosurgical trauma journal of neurotrauma 11 3 325 331 doi 10 1089 neu 1994 11 325 pmid 7996586 nordby hk nesbakken r 1984 the effect of high dose barbiturate decompression after severe head injury a controlled clinical trial acta neurochirurgica 72 3 4 157 166 doi 10 1007 bf01406868 pmid 6382945 s2cid 12215655 grocott hp update on techniques for neuroprotection during hypothermic arrest pdf society of cardiovascular anesthesiologists archived from the original pdf on 23 april 2016 retrieved 14 april 2016 approximately 60 of cmro2 is utilized for neuronal function with the remainder being required for cellular integrity cerebral protection and resuscitation cns clinic jordan amman archived from the original on 4 november 2020 retrieved 16 april 2016 the primary mechanism of protection involves a reduction in cmro2 of up to 55 to 60 at which point the eeg becomes isoelectric barbiturate coma trauma org archived from the original on 19 august 2016 retrieved 16 april 2016 therapeutic eeg response burst suppression or cortical electrical silence with preservation of ssep and baef schwartz ml tator ch rowed dw reid sr meguro k andrews df november 1984 the university of toronto head injury treatment study a prospective randomized comparison of pentobarbital and mannitol the canadian journal of neurological sciences le journal canadien des sciences neurologiques 11 4 434 440 doi 10 1017 s0317167100045960 pmid 6440704 schalén w sonesson b messeter k nordström g nordström ch 1992 clinical outcome and cognitive impairment in patients with severe head injuries treated with barbiturate coma acta neurochirurgica 117 3 4 153 159 doi 10 1007 bf01400613 pmid 1414516 s2cid 23032307 external links edit medically induced coma livescience v t e intensive care medicine health science medicine medical specialities respiratory therapy general terms intensive care unit icu neonatal intensive care unit nicu pediatric intensive care unit picu coronary care unit ccu critical illness insurance geriatric intensive care unit conditions organ system failure shock sequence sirs sepsis severe sepsis septic shock multiple organ dysfunction syndrome other shock cardiogenic shock distributive shock anaphylaxis obstructive shock neurogenic shock spinal shock vasodilatory shock organ failure acute renal failure acute respiratory distress syndrome acute liver failure respiratory failure multiple organ dysfunction syndrome neonatal infection polytrauma coma complications critical illness polyneuropathy myopathy critical illness related corticosteroid insufficiency decubitus ulcers fungemia stress hyperglycemia stress ulcer iatrogenesis methicillin resistant staphylococcus aureus oxygen toxicity refeeding syndrome ventilator associated lung injury ventilator associated pneumonia dialytrauma diagnosis arterial blood gas catheter arterial line central venous catheter pulmonary artery catheter blood cultures screening cultures life supporting treatments airway management and mechanical ventilation tracheal intubation cardiac devices intra aortic balloon pump ventricular assist device chest tube kidney dialysis early goal directed therapy induced coma nutritional supplementation enteral feeding total parenteral nutrition therapeutic hypothermia drugs analgesics antibiotics antithrombotics inotropes intravenous fluids neuromuscular blocking drugs recombinant activated protein c sedatives stress ulcer prevention drugs vasopressors icu scoring systems apache ii glasgow coma scale pim2 saps ii saps iii sofa physiology hemodynamics hypotension level of consciousness acid base imbalance water electrolyte imbalance organisations society of critical care medicine surviving sepsis campaign european 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