Clin Med
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The vegetative state (VS) is a devastating clinical condition characterised by wakefulness without awareness. Functional neuroimaging permits to objectively measure brain responsiveness to external stimuli in VS. The literature on functional magnetic resonance imaging and positron emission tomography studies in these patients has been reviewed. ⋯ Passive stimulation paradigms, however, do not permit to make strong claims about the absence or presence of consciousness. Recently proposed mental imagery paradigms permit to identify signs of consciousness in non-communicative brain damaged patients. The clinical application of these functional neuroimaging techniques awaits validation from ongoing multi-centric cohort studies in these challenging patients with chronic disorders of consciousness.
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Non-invasive ventilation (NIV) in the management of acute type 2 respiratory failure in patients with chronic obstructive pulmonary disease (COPD) represents one of the major technical advances in respiratory care over the last decade. This document updates the 2002 British Thoracic Society guidance and provides a specific focus on the use of NIV in COPD patients with acute type 2 respiratory failure. While there are a variety of ventilator units available most centres now use bi-level positive airways pressure units and this guideline refers specifically to this form of ventilatory support although many of the principles encompassed are applicable to other forms of NIV. The guideline has been produced for the clinician caring for COPD patients in the emergency and ward areas of acute hospitals.