Vegetative states--an integrative approach.

The integrative approach to vegetative state remains a challenge. In this article we have presented the evidence for conventional and alternative therapies that can be applied to this condition. Some are intended to support the patient and prevent complications; others enhance the ability of relatives to interact with their loved ones; while others are intended to shorten the vegetative state period. The approaches we reviewed were based on availability of data on MEDLINE and/or their potential to broaden our conceptual approach to vegetative state. Some approaches highlighted within the article including nutritional support, acupuncture, and homeopathy, seem to have a reasonable risk/benefit ratio. Yet, the complexity of vegetative state makes it challenging to recommend an integrative protocol. Rather we recommend an individualized approach, based on patient co-morbidities, caregiver and health professional preferences, and availability of therapists. Other approaches, including herbal medicine, mind-body therapies, intercessory prayer, energy medicine, and shamanism were not included due to the lack of available information and evidence. We acknowledge that a lack of evidence for efficacy is not equivalent to evidence for a lack of efficacy. Further research is critically needed to advance our treatment approach to this challenging state. Vegetative state is a condition that continues to humble the medical world. What we do not know eclipses that which we know. The critical question of what the vegetative state patient experiences continues to mystify us. Our philosophical stance insists that we treat the patient as one who is aware. Simultaneously we struggle with what, if anything, we can successfully do to "reawaken" the patient.