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Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study.

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Awareness with paralysis (AWP) affects 3.4% of mechanically ventilated emergency department patients, particularly those given rocuronium. This condition increases perceived threat, raising the risk for post-traumatic stress disorder (PTSD).

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Area of Science:

  • Critical Care Medicine
  • Neuroscience
  • Psychiatry

Background:

  • Awareness with paralysis (AWP) in mechanically ventilated patients can lead to severe psychological distress, including PTSD, depression, and suicidal ideation.
  • Emergency department (ED) data suggest AWP factors occur more frequently than in the operating room, yet data on critically ill patients remain scarce.

Purpose of the Study:

  • To determine the incidence of AWP in mechanically ventilated ED patients.
  • To identify modifiable factors associated with AWP occurrence in this population.

Main Methods:

  • A secondary analysis of a multicenter, prospective, before-and-after clinical trial involving 388 mechanically ventilated adult patients receiving neuromuscular blockers.
  • AWP was assessed using the modified Brice questionnaire and adjudicated by expert reviewers.
  • Perceived threat was evaluated as a secondary outcome.

Main Results:

  • The incidence of AWP was 3.4% (13/388 patients).
  • Rocuronium exposure was significantly associated with AWP (92.3% of AWP cases involved rocuronium; 5.5% of rocuronium recipients experienced AWP vs. 0.6% of non-recipients; OR 8.64).
  • Patients experiencing AWP reported higher perceived threat scores (15.6 vs. 7.7; p < 0.01).

Conclusions:

  • AWP affects a significant proportion of mechanically ventilated ED patients.
  • Rocuronium use in the ED is linked to an increased risk of AWP.
  • AWP is associated with heightened perceived threat, increasing vulnerability to PTSD; further research and prevention strategies are crucial.