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

机械通气急诊科幸存者对瘫痪和创伤后应激障碍的认识：ED-AWARENESS-2 研究

• 批准号: 10583909
• 负责人: Brian M Fuller
• 金额: $ 72.49万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-05 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583909
• 关键词: Accident and Emergency department; Acute respiratory failure; Attenuated; Awareness; Breathing; Caring; Clinical Trials; Cluster randomized trial; Collaborations; Complication; Critical Care; Critical Illness; Data; Development; Emergency Department patient; Event; Exclusion; Exposure to; Frequencies; Future; Goals; Hospitalization; Hospitals; Induction of neuromuscular blockade; Infrastructure; Intensive Care Units; Intervention; Intratracheal Intubation; Intubation; Investigation; Investments; Knowledge; Link; Literature; Low Prevalence; Mechanical ventilation; Medical; Memory; Mental Health; Methods; Morbidity - disease rate; Neuromuscular Blocking Agents; Odds Ratio; Operating Rooms; Outcome; Outcome Measure; Paralysed; Pathway interactions; Patient Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Prevalence; Prevention; Prevention strategy; Public Health; Respiratory Failure; Risk Factors; Role; Survivors; Symptoms; Testing; Time; Traumatic injury; Tube; Wakefulness; Work; clinically significant; cohort; critical period; design; disability; experience; improved; improved outcome; lens; memory recall; patient oriented; patient safety; pragmatic intervention; prevent; primary outcome; psychologic; psychological outcomes; sedative; sound; ventilation

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.

项目摘要/摘要 瘫痪的意识（AWP）或无意的意识是神经肌肉封锁期间记忆的记忆 （NMB）并可能造成灾难性的心理伤害。我们的团队最近表现出AWP的流行 机械通风急诊科（ED）患者的3.7％，比在 手术室（OR）。因此，在ED中检查AWP有很大的理由，其中30万 患者每年进行机械通风。创伤后应激障碍（PTSD）多达70％ 经历AWP的患者，约占所有重症患者的35％。但是，什么是未知的 学位机械通风的ED患者患有PTSD症状。此外，尽管总体经验 推动PTSD开发，以患者为中心的经验的知识，可以针对改进 结果缺乏。我们的长期目标是改善机械通风的以患者为中心的结果 沿ED到ICU界面的患者采用旨在预防的务实和可扩展干预措施。 为此，该提案的总体目标是进行务实的阶梯楔形群集随机 在五个学术急诊室中试用。中心假设是，通过使用旨在减少ED的轻推和默认值 使用Rocuronium，经历AWP的患者比例将大大减少。另外，我们 假设机械通风的ED患者遭受的心理负担很高，并且 可以使用混合方法方法来识别可修改的目标。科学文学和我们的 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要威胁，并制定在以后的试验中进行测试以进行测试以进行测试 改善未来幸存者的心理健康成果。该提案的公共卫生影响 居住在一个事实上，它可以很容易地实施，以防止每年数千例AWP案件。 此外，通过针对ED并通过以患者为中心的镜头检查心理结果，我们 预计结果将通过阐明长期的主要途径产生积极的公共卫生影响 心理疾病的心理后遗症，并阐明时间敏感的ED干预措施在贡献中的作用 这些结果。这将使我们能够开发特定的，有针对性的对策以改善长期 关键疾病幸存者的结果并确定有希望的预防ED实施策略。