Awareness with Paralysis and Post-Traumatic Stress Disorder among Mechanically Ventilated Emergency Department Survivors: The ED-AWARENESS-2 Study

项目总结/摘要 意识瘫痪（AWP），或无意意识，是在神经肌肉阻滞期间的记忆回忆 (NMB)并可能造成灾难性的心理伤害我们的团队最近证明了AWP的流行 在机械通气急诊科（艾德）患者中， 手术室（OR）因此，在艾德中检查AWP是有意义的，其中30万 每年对患者进行机械通气。创伤后应激障碍（PTSD）的发病率高达70%。 发生AWP的患者，约占所有危重通气患者的35%。然而，它是未知的， 中度机械通气的艾德患者出现PTSD症状。此外，虽然整体经验 推动创伤后应激障碍的发展，以患者为中心的经验，可以有针对性地改善 缺少结果。我们的长期目标是改善机械通气患者以患者为中心的结局。 沿着ED到ICU的接口，采取务实和可扩展的干预措施，旨在预防。 为此，本提案的总体目标是进行一次务实的、阶梯式的随机分组， 在五个学术ED中进行试验。中心假设是，通过使用轻推和默认旨在减少艾德 使用罗库溴铵后，发生AWP的患者比例将显著降低。另外我们 假设机械通气艾德患者的心理负担较高， 可以用混合方法确定可修改的目标。科学文献和我们的 初步数据提供了进行这项研究的基本原理，通过完成其目标，我们将 防止对患者安全的重大威胁，并开发干预措施，在未来的试验中进行测试， 改善幸存者的心理健康状况。这项提案对公众健康的影响 它的优点在于，它可以很容易地广泛实施，以防止每年成千上万的AWP病例。 此外，通过以艾德为目标，并通过以患者为中心的透镜检查心理结果， 结果预计将通过阐明长期的主要途径产生积极的公共卫生影响， 危重病的心理后遗症，并阐明对时间敏感的艾德干预在促进 这些结果。这将使我们能够制定具体的、有针对性的对策，以改善长期的 结果的重大疾病幸存者，并确定有前途的预防战略，艾德的实施。

PROJECT SUMMARY/ABSTRACT Awareness with paralysis (AWP), or unintentional awareness, is memory recall during neuromuscular blockade (NMB) and can cause catastrophic psychological harm. Our team recently demonstrated a prevalence of AWP of 3.7% in mechanically ventilated emergency department (ED) patients, 25 times higher than that observed in the operating room (OR). Therefore, there is significant rationale to examine AWP in the ED, where 300,000 patients are mechanically ventilated annually. Post-traumatic stress disorder (PTSD) develops in up to 70% of patients who experience AWP, and ~ 35% of all critically ill ventilated patients. However, it is unknown to what degree mechanically ventilated ED patients develop PTSD symptoms. Further, though the overall experience drives PTSD development, knowledge of patient-centered experiences that can be targeted to improve outcome is lacking. Our long-term goal is to improve patient-centered outcomes in mechanically ventilated patients along the ED-to-ICU interface with pragmatic and scalable interventions aimed at prevention. To that end, the overall objective of this proposal is to conduct a pragmatic, stepped wedge cluster randomized trial in five academic EDs. The central hypothesis is that by using nudges and defaults aimed at reducing ED rocuronium use, the proportion of patients experiencing AWP will be significantly reduced. In addition, we hypothesize that the psychological burden suffered by mechanically ventilated ED patients is high, and modifiable targets can be identified with a mixed-methods approach. The scientific literature and our preliminary data provide the rationale for conducting this study, and through completion of its aims we will prevent an important threat to patient safety, and develop interventions to be tested in future trials in effort to improve mental health outcomes in survivors going forward. The public health impact from this proposal resides in the fact that it can be readily implemented broadly to prevent thousands of cases of AWP annually. In addition, by targeting the ED and examining psychological outcomes through a patient-centered lens, our results are expected to have a positive public health impact by elucidating the principal pathways of long-term psychological sequelae of critical illness and clarifying the role of time-sensitive ED interventions in contributing to those outcomes. This will allow us to develop specific, targeted countermeasures to improve long-term outcomes for critical illness survivors and identify promising prevention strategies for ED implementation.