scholarly journals Protocol for a prospective, observational cohort study of awareness in mechanically ventilated patients admitted from the emergency department: the ED-AWARENESS study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e033379
Author(s):  
Ryan D Pappal ◽  
Brian W Roberts ◽  
Nicholas M Mohr ◽  
Enyo Ablordeppey ◽  
Brian T Wessman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Multivariable Analysis ◽  
Likelihood Estimation ◽  
Psychological Consequences ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Monitoring Of Sedation ◽  
Scientific Meetings ◽  
Ventilated Patients

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.

scholarly journals Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study

Critical Care ◽  
2018 ◽  
Vol 22 (1) ◽  
Author(s):  
David Page ◽  
Enyo Ablordeppey ◽  
Brian T. Wessman ◽  
Nicholas M. Mohr ◽  
Stephen Trzeciak ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Protocol for a multicentre, prospective cohort study of practice patterns and clinical outcomes associated with emergency department sedation for mechanically ventilated patients: the ED-SED Study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023423 ◽  
Author(s):  
Brian M Fuller ◽  
Nicholas M Mohr ◽  
Brian W Roberts ◽  
Christopher R Carpenter ◽  
Marin H Kollef ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Deep Sedation ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
The Impact ◽  
Ventilated Patients

IntroductionIn mechanically ventilated patients, sedation strategies are a major determinant of outcome. The emergency department (ED) is the earliest exposure to mechanical ventilation for hundreds of thousands of patients annually in the USA. The one retrospective study that exists regarding ED sedation for mechanically ventilated patients showed a strong association between deep sedation in the ED and worse clinical outcomes. This finding suggests that the ED may be an optimal location to study the impact of early sedation on outcome, yet a lack of prospective studies represents a knowledge gap in this arena. This protocol describes a prospective observational study aimed at further characterising ED sedation practices and assessing the relationship between ED sedation and clinical outcomes. An association between ED sedation and clinical outcomes across multiple sites would suggest the need for changes in the current sedation strategies used in the ED, and provide evidence for future interventional studies in this field.Methods and analysisThis is a multicentre, prospective cohort study testing the hypothesis that deep sedation in the ED is associated with worse clinical outcomes. A cohort of over 300 mechanically ventilated ED patients will be included. The primary outcome is ventilator-free days, and secondary outcomes include hospital mortality, incidence of acute brain dysfunction and lengths of stay. Multivariable linear regression will test the hypothesis that deep sedation in the ED is associated with a decrease in ventilator-free days.Ethics and disseminationApproval of the study by the Institutional Review Board (IRB) at each participating site has been obtained prior to data collection on the first patient. 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.

scholarly journals Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

2008 ◽  
Vol 126 (6) ◽  
pp. 319-322 ◽  
Author(s):  
Bruno Franco Mazza ◽  
José Luiz Gomes do Amaral ◽  
Heloisa Rosseti ◽  
Rosana Borges Carvalho ◽  
Ana Paula Resque Senna ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Arterial Blood ◽  
Before And After ◽  
High Risk Situation ◽  
Change In Mean ◽  
Ventilated Patients

CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with "before and after" evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.

scholarly journals Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study

2020 ◽  
Vol 201 (12) ◽  
pp. 1560-1564 ◽  
Author(s):  
David R. Ziehr ◽  
Jehan Alladina ◽  
Camille R. Petri ◽  
Jason H. Maley ◽  
Ari Moskowitz ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

230: Who's Watching the Vent?: Morbidity Associated With Mechanically Ventilated Patients in the Emergency Department

2008 ◽  
Vol 52 (4) ◽  
pp. S113
Author(s):  
D. Figueroa-Castaneda ◽  
D. Goldsmith ◽  
A. Suarez ◽  
S. Ristova ◽  
G. Martin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients
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