The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department - 23/04/21
Abstract |
Study objective |
Awareness with paralysis is a devastating complication for patients receiving mechanical ventilation and risks long-term psychological morbidity. Data from the emergency department (ED) demonstrate a high rate of longer-acting neuromuscular blocking agent use, delayed analgosedation, and a lack of sedation depth monitoring. These practices are discordant with recommendations for preventing awareness with paralysis. Despite this, awareness with paralysis has not been rigorously studied in the ED population. Our objective is to assess the prevalence of awareness with paralysis in ED patients receiving mechanical ventilation.
Methods |
This was a single-center, prospective, observational cohort study on 383 mechanically ventilated ED patients. After extubation, we assessed patients for awareness with paralysis by using the modified Brice questionnaire. Three expert reviewers independently adjudicated awareness with paralysis. We report the prevalence of awareness with paralysis (primary outcome); the secondary outcome was perceived threat, a mediator for development of posttraumatic stress disorder.
Results |
The prevalence of awareness with paralysis was 2.6% (10/383). Exposure to rocuronium at any point in the ED was significantly different between patients who experienced awareness with paralysis (70%) versus the rest of the cohort (31.4%) (unadjusted odds ratio 5.1; 95% confidence interval 1.30 to 20.1). Patients experiencing awareness with paralysis had higher mean values on the threat perception scale, denoting a higher degree of perceived threat, compared with patients who did not experience awareness with paralysis (13.4 [SD 7.7] versus 8.5 [SD 6.2]; mean difference 4.9; 95% confidence interval 0.94 to 8.8).
Conclusion |
Awareness with paralysis occurs in a significant minority of ED patients who receive mechanical ventilation. Potential associations of awareness with paralysis with ED care and increased perceived threat warrant further evaluation.
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| Please see page 533 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Michael Gottlieb, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: RDP and BMF were responsible for study conception. RDP, BWR, NMM, EA, BTW, AMD, YY, MHK, MSA, and BMF were responsible for study design. RDP, WW, and BMF were responsible for acquisition of data. BWR, NMM, and BMF were responsible for drafting the article. All authors were responsible for analysis and interpretation of data, revising the article, and reading and final approval of the submitted article. BMF takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Mr. Pappal received funding from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under award TL1TR002344. Mr. Winkler was supported by the NIH T35 NHLBI Training Grant (5T35HL007815). Dr. Fuller was supported by a grant-in-aid from the Division of Clinical and Translational Research of the Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO. |
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Vol 77 - N° 5
P. 532-544 - mai 2021 Retour au numéro
Article précédent
- Access to Optimal Emergency Care for Children
- Kathleen M. Brown, Alice D. Ackerman, Timothy K. Ruttan, Sally K. Snow, AMERICAN ACADEMY OF PEDIATRICS, Committee on Pediatric Emergency Medicine, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, Pediatric Emergency Medicine Committee, EMERGENCY NURSES ASSOCIATION, Pediatric Committee, 2019 Pediatric Committee Members, Gregory P. Conners, James Callahan, Toni Gross, Madeline Joseph, Lois Lee, Elizabeth Mack, Jennifer Marin, Suzan Mazor, Ronald Paul, Nathan Timm, Ann M. Dietrich, Kiyetta H. Alade, Christopher S. Amato, Zaza Atanelov, Marc Auerbach, Isabel A. Barata, Lee S. Benjamin, Kathleen T. Berg, Kathleen Brown, Cindy Chang, Jessica Chow, Corrie E. Chumpitazi, Ilene A. Claudius, Joshua Easter, Ashley Foster, Sean M. Fox, Marianne Gausche-Hill, Michael J. Gerardi, Jeffrey M. Goodloe, Melanie Heniff, James (Jim) L. Homme, Paul T. Ishimine, Susan D. John, Madeline M. Joseph, Samuel Hiu-Fung Lam, Simone L. Lawson, Moon O. Lee, Joyce Li, Sophia D. Lin, Dyllon Ivy Martini, Larry Bruce Mellick, Donna Mendez, Emory M. Petrack, Lauren Rice, Emily A. Rose, Timothy Ruttan, Mohsen Saidinejad, Genevieve Santillanes, Joelle N. Simpson, Shyam M. Sivasankar, Daniel Slubowski, Annalise Sorrentino, Michael J. Stoner, Carmen D. Sulton, Jonathan H. Valente, Samreen Vora, Jessica J. Wall, Dina Wallin, Theresa A. Walls, Muhammad Waseem, Dale P. Woolridge, Cam Brandt, Krisi M. Kult, Justin J. Milici, Nicholas A. Nelson, Michele A. Redlo, Maureen R. Curtis Cooper, Michele Redlo, Krisi Kult, Katherine Logee, Dixie Elizabeth Bryant, Maureen Curtis Cooper, Kristen Cline, Policy Statement, Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children
- Speechless: Awareness With Recall of Paralysis in the Emergency Department Setting
- Michael Gottlieb, Jestin N. Carlson
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