Transitions of Consciousness in Comatose Patients - Brain Bee Ideas - SBNeC - FALAN
Transitions of Consciousness in Comatose Patients - Brain Bee Ideas - SBNeC - FALAN
“When consciousness wants to return, it looks for a body that feels familiar.”
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Consciousness Seeks Familiarity
When consciousness wants to return, it looks for a body that feels familiar.
Imagine emerging from a deep dream into a body that now breathes differently, hears alarms, and experiences oxygen levels it has never felt before. For a brain attempting to reorganize full awareness after a coma, this strange environment can trigger what many clinicians refer to as a “lock” — a bodily struggle against the ventilator.
The standard clinical response at that moment is to deepen sedation, which may interrupt the natural process of conscious return.
But… what if consciousness is attempting to return in a healthy way, searching for the physiological state it recognizes as its natural habitat?
The so-called Zone 2 of SpO₂ (between 92–96%) is common during wakeful awareness, is associated with neurovascular balance, and may represent a more compatible environment for the reconstruction of conscious experience.
Neurocognitive Hypothesis
Consciousness, as an embodied process (Damasio, 1999), depends on interoceptive stability. A body that is artificially hyperoxygenated (>97% SpO₂) may feel foreign, impeding the reintegration of the interoceptive and proprioceptive signals that support a functional sense of self.
Zone 2 Assessment Proposal (SpO₂ 94–95%)
Topic: Controlled Oxygen Saturation Adjustment to Facilitate Conscious Transitions in Deeply Sedated Patients
1. Clinical Context
In patients showing preserved cortical signs (favorable electrical activity, stable hemodynamic parameters, no widespread severe lesions), the transition from induced unconsciousness to a conscious state may manifest through episodes of respiratory dyssynchrony — commonly identified as “fighting the ventilator.”
The routine response is to increase sedation, which might suppress a physiologically desirable conscious emergence.
2. Physiological Hypothesis
Based on recent neurophysiological evidence, we propose that artificially elevated peripheral oxygen saturation (>97%) may represent a perceptual barrier to consciousness reorganization, by drastically altering the body’s interoceptive signals.
The range between 92–96% (Zone 2) is associated with physiological cerebral vasodilation, preservation of neurovascular coupling, and improved oxygenation of the prefrontal cortex (PFC) — a critical region for attentional focus and emergence of conscious awareness (Zhou et al., 2022; Sato et al., 2021).
3. Proposal for Controlled Experimental Intervention
During episodes of respiratory dyssynchrony in patients in light coma or emerging from sedation:
Temporarily reduce FiO₂ to target SpO₂ between 94–95%.
Monitor:
Hemodynamic stability
Respiratory effort index
BIS (bispectral index)
Capnography (exhaled CO₂ levels)
Assess: whether the adjustment improves respiratory synchrony and reduces the need for re-sedation.
4. Clinical and Scientific References
Zhou et al. (2022, Front. Neurosci.): Optimized cognitive performance in SpO₂ 94–97%, with enhanced executive control.
MIMIC-IV (2023): Lower hospital mortality in critically ill patients with SpO₂ between 92–96%.
Bailey et al. (2019): Physiological CO₂ levels improve cerebral perfusion in the PFC.
LOCO₂, ICU-ROX, HOT-ICU Trials: Both hyperoxia (>96%) and hypoxia (<90%) are associated with increased mortality.
British Thoracic Society (2023), NICE Guidelines: Recommend 92–96% as the safe range of normoxemia.
Sato et al. (2021, NeuroImage), Tran et al. (2023, Scientific Reports): fNIRS and EEG show increased prefrontal oxygenation and correlation with attentional focus in the 94–96% range.
5. Potential Benefits
Reduction of patient–ventilator dyssynchrony
Decreased need for sedatives and anesthetics
Smoother, more physiological transition to consciousness
Preservation of neurophysiological autonomy
Potential cognitive reorganization benefits post-coma
6. Ethical Considerations
This proposal should be regarded as an exploratory observational intervention, with proper documentation in the medical record, informed family consent (when applicable), and grounded in the principles of beneficence, non-maleficence, and respect for reorganizing consciousness.
7. Conclusion
A brief transition into Zone 2 of SpO₂ (94–95%) during the reemergence of consciousness may represent a safe, physiological, and internally coherent alternative for conscious reintegration.
As Cionek (2025) suggests:
“When consciousness wants to return, it looks for a body that feels familiar.”
The ICU can — and should — be that place of reconnection between body and mind.
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