# Awareness with Paralysis and Post-Traumatic Stress Disorder among Mechanically Ventilated Emergency Department Survivors: The ED-AWARENESS-2 Study

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2024 · $665,576

## Abstract

PROJECT SUMMARY/ABSTRACT
Awareness with paralysis (AWP), or unintentional awareness, is memory recall during neuromuscular blockade
(NMB) and can cause catastrophic psychological harm. Our team recently demonstrated a prevalence of AWP
of 3.7% in mechanically ventilated emergency department (ED) patients, 25 times higher than that observed in
the operating room (OR). Therefore, there is significant rationale to examine AWP in the ED, where 300,000
patients are mechanically ventilated annually. Post-traumatic stress disorder (PTSD) develops in up to 70% of
patients who experience AWP, and ~ 35% of all critically ill ventilated patients. However, it is unknown to what
degree mechanically ventilated ED patients develop PTSD symptoms. Further, though the overall experience
drives PTSD development, knowledge of patient-centered experiences that can be targeted to improve
outcome is lacking. Our long-term goal is to improve patient-centered outcomes in mechanically ventilated
patients along the ED-to-ICU interface with pragmatic and scalable interventions aimed at prevention.
To that end, the overall objective of this proposal is to conduct a pragmatic, stepped wedge cluster randomized
trial in five academic EDs. The central hypothesis is that by using nudges and defaults aimed at reducing ED
rocuronium use, the proportion of patients experiencing AWP will be significantly reduced. In addition, we
hypothesize that the psychological burden suffered by mechanically ventilated ED patients is high, and
modifiable targets can be identified with a mixed-methods approach. The scientific literature and our
preliminary data provide the rationale for conducting this study, and through completion of its aims we will
prevent an important threat to patient safety, and develop interventions to be tested in future trials in effort to
improve mental health outcomes in survivors going forward. The public health impact from this proposal
resides in the fact that it can be readily implemented broadly to prevent thousands of cases of AWP annually.
In addition, by targeting the ED and examining psychological outcomes through a patient-centered lens, our
results are expected to have a positive public health impact by elucidating the principal pathways of long-term
psychological sequelae of critical illness and clarifying the role of time-sensitive ED interventions in contributing
to those outcomes. This will allow us to develop specific, targeted countermeasures to improve long-term
outcomes for critical illness survivors and identify promising prevention strategies for ED implementation.

## Key facts

- **NIH application ID:** 10802187
- **Project number:** 5R01HL162721-02
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Brian M Fuller
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $665,576
- **Award type:** 5
- **Project period:** 2023-03-05 → 2028-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10802187

## Citation

> US National Institutes of Health, RePORTER application 10802187, Awareness with Paralysis and Post-Traumatic Stress Disorder among Mechanically Ventilated Emergency Department Survivors: The ED-AWARENESS-2 Study (5R01HL162721-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10802187. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*