At sixteen, one should be in the bloom of youth,

But for 16-year-old Xiao Wang,

A car accident on August 19, 2019,

Yet it left him, at an age when he should have been making beautiful memories,

Having endured hardships unimaginable to their peers,

He has been diagnosed with a permanent vegetative state!

Literally speaking, in plain terms, it means a permanent vegetative state—nothing less than a death sentence, delivering a devastating blow to Xiao Wang’s family. Yet Xiao Wang’s mother refused to give up. On September 26, 2019, Xiao Wang was transferred to Nanjing Zijin Hospital for awakening therapy.

“Effort never betrays the dedicated,” and, moved by the call of maternal love, after undergoing medication, hyperbaric oxygen therapy, and a comprehensive rehabilitation program, little Wang regained consciousness on July 3, 2021, after 23 months—and uttered his first word: “Mom.” That single word left everyone in the ward in awe.

Having been diagnosed with a “permanent vegetative state,” the patient unexpectedly regained consciousness 23 months later! This was the case presented by Director Ma Hulong at the 2022 in-hospital case report symposium held at Nanjing Zijin Hospital.

Director Ma Hulong

Seminar venue

This case report has once again drawn attention to the term “permanent vegetative state (PVS).” As noted in the 2020 interpretation of the 2018 American Practice Guideline for Disorders of Consciousness, authored by He Jianghong, Yang Yi, and others, disorders of consciousness (DOC) refer to states of sustained loss of consciousness that arise following various types of brain injury, encompassing two levels: the vegetative state (VS) and the minimally conscious state (MCS).

Over the past two decades, the field of chronic obstructive disease has undergone numerous significant developments in mechanisms, diagnosis, and treatment. Consequently, organizations including the AAN and the American Academy of Physical Medicine and Rehabilitation jointly reviewed recent research reports and issued an updated guideline in 2018.

In addition to providing new definitions for the concepts of VS and MCS, the new guidelines also offer tiered treatment recommendations. They include evidence-based recommendations for the management and care of patients with DOC:

1. A clear definition: DOC refers to a state of consciousness in which, following various types of brain injury, the disturbance of consciousness persists for more than 28 days.

2. DOC patients were classified into two major categories—vegetative state (VS) and minimally conscious state (MCS)—based on their level of consciousness.

3. Prognostic predictions have become more cautious; the diagnosis of “permanent vegetative state” has been discontinued and replaced with “chronic vegetative state,” while “persistent VS” has been reclassified as “vegetative state plus disease duration.”

The case report presented by Director Ma Hulong concerns a patient recently treated at our hospital who had previously been classified as being in a “permanent vegetative state.” In fact, over the hospital’s 35-year history, there have been several similar cases of patients achieving recovery. Accordingly, abolishing the term “permanent vegetative state” and replacing it with “chronic vegetative state,” in the editor’s view, not only reflects a rigorous medical approach but also embodies compassionate care for the patients’ families.

Transitioning from a vegetative state to full consciousness—Mr. Wang, as a patient in a vegetative state, is fortunate. Yet, in a very small minority of comatose patients, even after regaining awareness and preparing for discharge, they may relapse into a coma. Why does this happen?

At the recent in-house case report symposium held at Zijin Hospital, a case report presented by Associate Chief Physician Pan Xingming from Ward 102 of the Jiangning Campus drew widespread attention.

Patient Wei was admitted to Nanjing Zijin Hospital on February 12, 2022, following 36 days of confusion, for neurorehabilitation therapy; at that time, the patient was dependent on a tracheostomy. Following comprehensive rehabilitation, including hyperbaric oxygen therapy, the patient’s level of consciousness improved. After assessment, the patient met the criteria for removal of the tracheal cannula, and the cannula was successfully removed on April 17. However, on May 1, Patient Wei experienced a decline in consciousness and again fell into a comatose state.

Why did a patient who was originally scheduled for discharge suddenly develop a fever and subsequently lapse into a coma? The physicians promptly initiated a comprehensive workup, and fiberoptic bronchoscopy with endotracheal intubation revealed subglottic granulomatous hyperplasia. Ultimately, it was determined that the patient’s deteriorating level of consciousness was attributable to airway obstruction and hypoxemia caused by an intratracheal granuloma; a tracheostomy was performed without delay. Following two weeks of comprehensive therapy, including hyperbaric oxygen treatment, the patient progressed to a minimally conscious state, and after two months, his mental status finally improved.

Wei’s consciousness map

In addition to the two case reports mentioned above, this hospital‑based case conference also addressed the remarkable therapeutic efficacy of hyperbaric oxygen therapy in various cases of disorders of consciousness, as well as the role of emerging technologies in rehabilitation in facilitating the recovery of awareness among patients with such conditions. Participants provided detailed discussions covering patients’ medical histories, clinical signs and symptoms, treatment courses, disease progression, and rehabilitation care.

This in‑house case report symposium was chaired by Xiao Feng, Director of the Hospital’s Medical Affairs Department, and attended by hospital leadership, department heads, and more than 70 medical staff members. Participants were divided into two groups—the Zhiyuan Group and the Zhishan Group—and each group took turns presenting on behalf of its team. Vice President Wang Yifang guided both groups in identifying strengths and addressing areas for improvement in the case reports, fostering a lively academic atmosphere characterized by enthusiastic discussion and active participation.

Vice Dean Wang Yifang

Executive Vice President Gao Zhiqiang delivered a concluding address at the case‑reporting symposium. He expressed his hope that the hospital would regularly host such forums, using this format to enhance everyone’s skills in case reporting and to bridge the gap between research and clinical practice. Of course, it is by recognizing our shortcomings that we can make progress. President Gao emphasized that, going forward, all participants should further cultivate rigorous, in‑depth logical thinking and gather more robust, dynamic data to support their reports, thereby producing even higher‑quality case studies. In closing, he quoted Confucius from the Analects: “To learn and constantly put what one has learned into practice—how delightful!”—encouraging everyone to work together toward the vision and goal of “excellence through sincerity and compassion, with far-reaching benevolence.”

Executive Vice President Gao Zhiqiang