Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Medicine, Division of Pulmonary and Critical Care, Hennepin County Medical Center, Minneapolis, MN.
Chest. 2023 Feb;163(2):313-323. doi: 10.1016/j.chest.2022.08.2232. Epub 2022 Sep 8.
Critically ill patients sometimes remember periods of neuromuscular blockade.
What is the prevalence of recalled awareness during paralysis in patients who underwent emergency tracheal intubation and mechanical ventilation, and what clinical variables are associated with this outcome?
This study analyzed data from a prospectively collected continuous quality improvement database of emergency tracheal intubation in an urban, county hospital. Patients who received a neuromuscular blocking agent to facilitate emergency tracheal intubation in the ED were included. The database contained details of intubation management, including medications received and patient mental status prior to intubation. Patient recall of awareness of paralysis was assessed by trained staff during an in-person interview following extubation using a modified Brice questionnaire. For this analysis, three expert reviewers used these data to adjudicate whether patients may have had awareness of paralysis, the primary outcome. A logistic regression model was constructed to determine whether clinical variables were associated with the primary outcome.
A total of 886 patients were analyzed. There were 66 patients (7.4%; 95% CI, 5.8-9.4) determined to possibly (61 patients) or definitely (5 patients) have experienced and recalled awareness of paralysis. A logistic regression model revealed that a decreased level of consciousness prior to intubation was associated with lower odds of awareness (adjusted OR, 0.39; 95% CI, 0.22-0.69), whereas the class of neuromuscular blocking agent used, sedative used, preintubation shock index, and postintubation sedation were not significantly associated with recall of this outcome.
Among patients intubated emergently using a neuromuscular blocking agent, 7.4% of patients recalled awareness without being able to move, which was more likely when patients had a normal level of consciousness prior to intubation.
危重症患者有时会回忆起神经肌肉阻滞期间的某些时段。
在接受急诊气管插管和机械通气的患者中，出现麻痹后意识恢复的比例是多少？哪些临床变量与这种结果相关？
这项研究分析了一家城市县医院急诊气管插管连续质量改进数据库中的前瞻性数据。纳入了在急诊科接受神经肌肉阻滞剂以辅助紧急气管插管的患者。该数据库包含了插管管理的详细信息，包括使用的药物和插管前患者的精神状态。在拔管后，由经过培训的工作人员使用改良 Brice 问卷对患者进行麻痹后意识恢复的评估。在这项分析中，三位专家评审员使用这些数据来判断患者是否可能经历过麻痹后意识恢复，这是主要结局。构建了逻辑回归模型，以确定临床变量是否与主要结局相关。
共分析了 886 名患者。有 66 名患者（7.4%；95%CI，5.8-9.4）可能（61 名患者）或确定（5 名患者）经历过并回忆起麻痹后意识恢复。逻辑回归模型显示，插管前意识水平降低与意识恢复的可能性降低相关（调整后的 OR，0.39；95%CI，0.22-0.69），而使用的神经肌肉阻滞剂类型、插管前使用的镇静剂、插管前休克指数和插管后镇静剂与该结果的回忆无显著相关性。
在使用神经肌肉阻滞剂紧急插管的患者中，有 7.4%的患者回忆起无法移动时的意识，而在插管前意识水平正常的患者中，这种情况更有可能发生。
