Disorders of consciousness diagnosis, interventions, and prognostication for the intensivist: Report of the 2025 ISICEM roundtable

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.