Journal article
Protocol for a prospective, observational cohort study of awareness in mechanically ventilated patients admitted from the emergency department: the ED-AWARENESS study
BMJ open, Vol.9(10), pp.e033379-e033379
10/2019
DOI: 10.1136/bmjopen-2019-033379
PMCID: PMC6797343
PMID: 31594905
Abstract
IntroductionAwareness with paralysis is a complication with potentially devastating psychological consequences for mechanically ventilated patients. While rigorous investigation into awareness has occurred for operating room patients, little attention has been paid outside of this domain. Mechanically ventilated patients in the emergency department (ED) have been historically managed in a way that predisposes them to awareness events: high incidence of neuromuscular blockade use, underdosing of analgesia and sedation, delayed administration of analgesia and sedation after intubation, and a lack of monitoring of sedation targets and depth. These practice patterns are discordant to recommendations for reducing the incidence of awareness, suggesting there is significant rationale to examine awareness in the ED population.Methods and analysisThis is a single centre, prospective cohort study examining the incidence of awareness in mechanically ventilated ED patients. A cohort of 383 mechanically ventilated ED patients will be included. The primary outcome is awareness with paralysis. Qualitative reports of all awareness events will be provided. Recognising the potential problem with conventional multivariable analysis arising from a small number of events (expected less than 10—phenomenon of separation), Firth penalised method, exact logistic regression model or penalised maximum likelihood estimation shrinkage (Ridge, LASSO) will be used to assess for predictors of awareness.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.
Details
- Title: Subtitle
- Protocol for a prospective, observational cohort study of awareness in mechanically ventilated patients admitted from the emergency department: the ED-AWARENESS study
- Creators
- Ryan D Pappal - Washington University in St. LouisBrian W Roberts - Cooper Medical School of Rowan UniversityNicholas M Mohr - University of IowaEnyo Ablordeppey - Washington University in St. LouisBrian T Wessman - Washington University in St. LouisAnne M Drewry - Washington University in St. LouisYan Yan - VA St. Louis Health Care SystemMarin H Kollef - Washington University in St. LouisMichael Simon Avidan - Washington University in St. LouisBrian M Fuller - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- BMJ open, Vol.9(10), pp.e033379-e033379
- DOI
- 10.1136/bmjopen-2019-033379
- PMID
- 31594905
- PMCID
- PMC6797343
- NLM abbreviation
- BMJ Open
- ISSN
- 2044-6055
- eISSN
- 2044-6055
- Language
- English
- Date published
- 10/2019
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984296149902771
Metrics
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