Observational studyAnnals of emergency medicine2021
The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department.
Observational study in Annals of emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Systematic review and meta-analysis of the correlation between bispectral index (BIS) and clinical sedation scales: Toward defining the role of BIS in critically ill patients.Pharmacotherapy · 2022Pooled it
- Awareness With Paralysis in Mechanically Ventilated Patients in the Emergency Department and ICU: A Systematic Review and Meta-Analysis.Critical care medicine · 2021Pooled it
- HOPFIT: A neuro-cardiovascular monitoring framework for precision sedation, anaesthesia, and resuscitation.Journal of clinical monitoring and computing · 2026Review
- Maintenance of prehospital anaesthesia using an intermittent bolus regime in blunt trauma patients with a high GCS and hemodynamic reserve: a retrospective cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Observational
- Rescue sedation administered to mechanically ventilated patients undergoing interhospital transfer by a South African aeromedical service: A retrospective review.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026Article
- Outcomes of Succinylcholine and Rocuronium for Rapid Sequence Intubation in the Emergency Department.The western journal of emergency medicine · 2026Article
- Exploring Demographic Differences in Postintubation Analgesia by Racial Group, Sex, and Age.The Journal of emergency medicine · 2026Article
- Administration of Post-intubation Analgesia and Sedation in Injured Patients in New Brunswick EDs.Cureus · 2026Article
- Time to Sedation and Analgesia After Rapid Sequence Intubation in the Emergency Department.Emergency medicine Australasia : EMA · 2026Article
- Population Pharmacokinetics of Propofol in Critically Ill Patients with and Without Extracorporeal Membrane Oxygenation.Clinical pharmacokinetics · 2026Observational
- Guideline-Concordant Sedative and Analgesia Use in Critically Ill Patients Receiving Sustained Neuromuscular Blockade.Critical care explorations · 2026Article
- Post-intubation sedation in the emergency department: A scoping review.The American journal of emergency medicine · 2026Article
- Management of Mechanical Ventilation in Emergency Medicine: A Scoping Review.Journal of the American College of Emergency Physicians open · 2026Review
- The Pharmacology of Physiologically Difficult Airway Management and Impact on Hemodynamics: A Review.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Review
- Clinical Electroencephalography for Anesthesiologists and Intensivists: Part 2-Physiologic Signatures and Active Management.Anesthesiology · 2025Review
- Use of Muscle Relaxants in Emergency Medicine: A Review.Medical science monitor : international medical journal of experimental and clinical research · 2025Review
- Use and Outcomes of Sugammadex for Neurological Examination after Neuromuscular Blockade in the Emergency Department.The western journal of emergency medicine · 2025Article
- Maintenance of prehospital anaesthesia in trauma patients: inconsistencies and variability in practice.BJA open · 2025Article
- Anesthesia for Bronchoscopy-An Update.Journal of clinical medicine · 2024Review
- A plea for enhanced monitoring of depth of sedation in patients who are intubated and ventilated.Critical care (London, England) · 2024Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
STUDY
objectiveAwareness with paralysis is a devastating complication for patients receiving mechanical ventilation and risks long-term psychological morbidity. Data from the emergency department (ED) demonstrate a high rate of longer-acting neuromuscular blocking agent use, delayed analgosedation, and a lack of sedation depth monitoring. These practices are discordant with recommendations for preventing awareness with paralysis. Despite this, awareness with paralysis has not been rigorously studied in the ED population. Our objective is to assess the prevalence of awareness with paralysis in ED patients receiving mechanical ventilation.
methodsThis was a single-center, prospective, observational cohort study on 383 mechanically ventilated ED patients. After extubation, we assessed patients for awareness with paralysis by using the modified Brice questionnaire. Three expert reviewers independently adjudicated awareness with paralysis. We report the prevalence of awareness with paralysis (primary outcome); the secondary outcome was perceived threat, a mediator for development of posttraumatic stress disorder.
resultsThe prevalence of awareness with paralysis was 2.6% (10/383). Exposure to rocuronium at any point in the ED was significantly different between patients who experienced awareness with paralysis (70%) versus the rest of the cohort (31.4%) (unadjusted odds ratio 5.1; 95% confidence interval 1.30 to 20.1). Patients experiencing awareness with paralysis had higher mean values on the threat perception scale, denoting a higher degree of perceived threat, compared with patients who did not experience awareness with paralysis (13.4 [SD 7.7] versus 8.5 [SD 6.2]; mean difference 4.9; 95% confidence interval 0.94 to 8.8).
conclusionAwareness with paralysis occurs in a significant minority of ED patients who receive mechanical ventilation. Potential associations of awareness with paralysis with ED care and increased perceived threat warrant further evaluation.
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