Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study.
Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study.
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DOI：
10.1097/ccm.0000000000005626
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发表时间：
2022-10-01
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
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在机械通气患者中，意识瘫痪（AWP）可能会产生破坏性后果，包括创伤后应激障碍（PTSD），抑郁症和自杀念头。来自急诊科（艾德）的单中心数据表明AWP因素的事件发生率高于手术室报告的事件发生率。然而，仍然缺乏关于重症机械通气患者AWP的数据。目的是评估艾德患者发生AWP的比例，并研究与其发生相关的可修改变量。一项多中心、前瞻性、前后临床试验的先验计划次要分析。三个学术医疗中心的艾德。接受神经肌肉阻滞剂的机械通气成人患者。无收集所有与镇静和镇痛相关的数据。AWP是主要结局，采用改良Brice问卷进行评估，并由三位专家评审员独立裁定。在PTSD的因果通路中，感知威胁是次要结局。共有388名患者参加了研究。发生AWP的患者比例为3.4%（n= 13），其中大多数接受罗库溴铵治疗（n= 12/13; 92.3%）。在接受罗库的患者中，5.5%（n= 12/230）发生AWP，而在艾德未接受罗库的患者中，AWP发生率为0.6%（n= 1/158）[比值比，8.64; 95%置信区间（CI）1.11 - 67.15]。与无AWP的患者相比，发生AWP的患者具有更高的平均（标准差）威胁感知量表评分[15.6（5.8）vs. 7.7（6.0），p < 0.01]。AWP在机械通气艾德患者中存在的比例相关，与艾德中的罗库溴铵暴露相关，并导致感知威胁水平增加，使患者处于更大的PTSD风险中。迫切需要进行旨在进一步量化这一弱势群体的AWP并消除其发生的研究。
In mechanically ventilated patients, awareness with paralysis (AWP) can have devastating consequences, including post-traumatic stress disorder (PTSD), depression, and thoughts of suicide. Single-center data from the emergency department (ED) demonstrate an event rate for AWP factors higher than that reported from the operating room. However, there remains a lack of data on AWP among critically ill, mechanically ventilated patients. The objective was to assess the proportion of ED patients experiencing AWP and investigate modifiable variables associated with its occurrence. An a priori planned secondary analysis of a multicenter, prospective, before-and-after clinical trial. The ED of three academic medical centers. Mechanically ventilated adult patients that received neuromuscular blockers. None All data related to sedation and analgesia were collected. AWP was the primary outcome, assessed with the modified Brice questionnaire, and was independently adjudicated by three expert reviewers. Perceived threat, in the causal pathway for PTSD, was the secondary outcome. A total of 388 patients were studied. The proportion of patients experiencing AWP was 3.4% (n= 13), the majority of whom received rocuronium (n= 12/13; 92.3%). Among patients who received rocuronium, 5.5% (n= 12/230) experienced AWP, compared to 0.6% (n= 1/158) among patients who did not receive rocuronium in the ED [odds ratio, 8.64; 95% confidence interval (CI) 1.11 to 67.15]. Patients experiencing AWP had a higher mean (standard deviation) threat perception scale score, compared to patients without AWP [15.6 (5.8) vs. 7.7 (6.0), p < 0.01]. AWP was present in a concerning proportion of mechanically ventilated ED patients, was associated with rocuronium exposure in the ED, and led to increased levels of perceived threat, placing patients at greater risk for PTSD. Studies that aim to further quantify AWP in this vulnerable population and eliminate its occurrence are urgently needed.
DOI：
10.1038/s43856-021-00067-3
发表时间：
2022
期刊：
COMMUNICATIONS MEDICINE
影响因子：
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作者：
Saegerman, Claude;Diep, Anh Nguyet;Renault, Veronique;Donneau, Anne-Francoise;Stamatakis, Lambert;Coppieters, Wouter;Michel, Fabienne;Breuer, Christophe;Dandoy, Margaux;Ek, Olivier;Gourzones, Claire;Schyns, Joey;Goffin, Emeline;Minner, Frederic;Durkin, Keith;Artesi, Maria;Bours, Vincent;Bureau, Fabrice;Gillet, Laurent
通讯作者：
Gillet, Laurent
影响因子：
7
作者：
Zhu DR;Julian J;Lee SJA;Thanataveerat A;Sumner JA
通讯作者：
Sumner JA
DOI：
10.1177/13524585221080542
发表时间：
2022-09
期刊：
Multiple sclerosis (Houndmills, Basingstoke, England)
影响因子：
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通讯作者：
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