TY - JOUR
T1 - Prevalence, proportionality, and cause of ventilator alarms in a pediatric intensive care setting
AU - Langga, Leo
AU - Oh, Jisoo
AU - López, David
AU - Blake, Nancy
AU - McField, Edward
AU - Hotz, Justin
AU - Nava-Guerra, Leonardo
AU - Knox, Kelby
AU - Chinnock, Richard
N1 - Publisher Copyright:
© 2021 Daedalus Enterprises.
PY - 2021/4
Y1 - 2021/4
N2 - BACKGROUND: Clinical alarms play an important role in monitoring physiological parameters, vital signs and medical device function in the hospital intensive care environment. Delays in staff response to alarms are well documented as health care providers become desensitized to increased rates of nuisance alarms. Patients can be at increased risk of harm due to alarm fatigue. Current literature suggests alarms from ventilators contribute significantly to nonactionable alarms. A greater understanding of which specific ventilator alarms are most common and the rates at which they occur is fundamental to improving alarm management. METHODS: A retrospective review was performed on alarms that occurred on the Avea and Servo-i ventilators used in the pediatric ICU and pediatric cardiothoracic ICU at a major metropolitan children’s hospital. High-and medium-pri-ority alarms, as classified by the manufacturer, were studied between June 1, 2017, and November 31, 2017. Descriptive data analysis and a 2-proportion z-test were performed to identify proportional-ity, cause, and prevalence rates in the pediatric ICU and the cardiothoracic ICU. RESULTS: Eleven distinct ventilator alarms were identified during 2,091 d of mechanical ventilation. The Inspiratory Flow Overrange alarm (42.4%) on the Servo-i, Low VTE (20.4%; expiratory tidal volume) and Circuit Integrity alarm (20.0%) on the Avea were the most prevalent causes according to ventilator type. Medium-priority alarms comprised 68.7% of all Servo-i alarms, and high-priority alarms comprised 84% of all Avea alarms. The 2-sample test of proportions was significant for differences betweenbothareas(P < .001). The overall alarm prevalence rate was 22.5 ventilator alarms per ven-tilator-day per patient. CONCLUSIONS: The cause and proportion of alarms varied by ventilator and care unit. High-priority alarms were most common with the Avea and medium-priority alarms for the Servo-i. The overall combined ventilator alarm prevalence rate was 22.5 alarms per ventilator-day per patient.
AB - BACKGROUND: Clinical alarms play an important role in monitoring physiological parameters, vital signs and medical device function in the hospital intensive care environment. Delays in staff response to alarms are well documented as health care providers become desensitized to increased rates of nuisance alarms. Patients can be at increased risk of harm due to alarm fatigue. Current literature suggests alarms from ventilators contribute significantly to nonactionable alarms. A greater understanding of which specific ventilator alarms are most common and the rates at which they occur is fundamental to improving alarm management. METHODS: A retrospective review was performed on alarms that occurred on the Avea and Servo-i ventilators used in the pediatric ICU and pediatric cardiothoracic ICU at a major metropolitan children’s hospital. High-and medium-pri-ority alarms, as classified by the manufacturer, were studied between June 1, 2017, and November 31, 2017. Descriptive data analysis and a 2-proportion z-test were performed to identify proportional-ity, cause, and prevalence rates in the pediatric ICU and the cardiothoracic ICU. RESULTS: Eleven distinct ventilator alarms were identified during 2,091 d of mechanical ventilation. The Inspiratory Flow Overrange alarm (42.4%) on the Servo-i, Low VTE (20.4%; expiratory tidal volume) and Circuit Integrity alarm (20.0%) on the Avea were the most prevalent causes according to ventilator type. Medium-priority alarms comprised 68.7% of all Servo-i alarms, and high-priority alarms comprised 84% of all Avea alarms. The 2-sample test of proportions was significant for differences betweenbothareas(P < .001). The overall alarm prevalence rate was 22.5 ventilator alarms per ven-tilator-day per patient. CONCLUSIONS: The cause and proportion of alarms varied by ventilator and care unit. High-priority alarms were most common with the Avea and medium-priority alarms for the Servo-i. The overall combined ventilator alarm prevalence rate was 22.5 alarms per ventilator-day per patient.
KW - Alarm fatigue
KW - Alarm priority
KW - Cause
KW - Critical alarm
KW - Frequency
KW - Pediatric intensive care unit
KW - Prevalence
KW - Proportionality
KW - Rate
KW - Ventilator alarms
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U2 - 10.4187/respcare.07200
DO - 10.4187/respcare.07200
M3 - Article
C2 - 33293363
SN - 0020-1324
VL - 66
SP - 541
EP - 550
JO - Respiratory Care
JF - Respiratory Care
IS - 4
ER -