This study investigated covert awareness—preserved consciousness without observable behavioral signs—in critically ill patients with acute brain injuries in the Intensive Care Unit (ICU).

Researchers used functional near-infrared spectroscopy (fNIRS), a portable bedside neuroimaging technique, on 32 patients who could not follow commands.

The patients were instructed to perform a mental imagery task (imagining playing tennis) to see if they could willfully modulate their brain activity.

A significant 25% (8 out of 32) of the acutely brain-injured patients showed this evidence of covert awareness.

The study found no link between this hidden awareness and a patient’s functional outcome three months later.

The findings demonstrate that fNIRS can successfully detect preserved consciousness in a substantial portion of non-responsive ICU patients. This highlights the potential of advanced neuroimaging to provide a more accurate assessment of a patient’s awareness level, which is critical for making informed goals of care decisions.

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