The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department.

Autor: Pappal RD; Washington University School of Medicine in St. Louis, St. Louis, MO., Roberts BW; Department of Emergency Medicine, Cooper University Hospital, Camden, NJ., Mohr NM; Departments of Emergency Medicine and Anesthesiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA., Ablordeppey E; Department of Emergency Medicine, St. Louis, MO; Department of Anesthesiology, St. Louis, MO., Wessman BT; Department of Emergency Medicine, St. Louis, MO; Department of Anesthesiology, St. Louis, MO., Drewry AM; Department of Anesthesiology, St. Louis, MO., Winkler W; Washington University School of Medicine in St. Louis, St. Louis, MO., Yan Y; Public Health Sciences, St. Louis, MO; Clinical Epidemiology Center, VA St. Louis Health Care System, St. Louis, MO., Kollef MH; Department of Medicine, St. Louis, MO., Avidan MS; Department of Anesthesiology, St. Louis, MO., Fuller BM; Department of Emergency Medicine, St. Louis, MO; Department of Anesthesiology, St. Louis, MO. Electronic address: fullerb@wustl.edu.
Jazyk: angličtina
Zdroj: Annals of emergency medicine [Ann Emerg Med] 2021 May; Vol. 77 (5), pp. 532-544. Date of Electronic Publication: 2021 Jan 21.
DOI: 10.1016/j.annemergmed.2020.10.012
Abstrakt: 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.
(Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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