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Alarm Limits for Intraoperative Drug Infusions: A Report From the Multicenter Perioperative Outcomes Group.
Mitchell F Berman1, Nikhil Iyer, Leon Freudzon
1From the *Department of Anesthesiology, Columbia University Medical Center, New York, New York; †Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; ‡Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; §Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; and ‖Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Infusion pump alarm settings can be standardized using 90th and 95th percentile rates derived from actual surgical usage data. This approach enhances patient safety by ensuring alarms trigger predictably during continuous medication infusions.
Area of Science:
- Anesthesiology
- Pharmacology
- Medical Device Safety
Background:
- Continuous medication infusions are vital in surgery, necessitating reliable infusion pump alarm settings.
- Current alarm limits lack standardization based on real-world usage data, posing potential patient safety risks.
Purpose of the Study:
- To estimate 90th and 95th percentile infusion rates from a national database.
- To provide data for establishing standardized, usage-based upper limit alarm settings for infusion pumps.
Main Methods:
- Infusion rate data were extracted from 17 hospitals (2008-2014) for seven common infusions (propofol, remifentanil, dexmedetomidine, norepinephrine, phenylephrine, nitroglycerin, esmolol).
- Quantile regression analyzed factors influencing percentile rates, such as general anesthesia versus sedation.
Main Results:
- Median 90th/95th percentile rates for propofol were 150/170 μg/kg/min; higher rates observed during sedation for endoscopy.
- For vasoactive drugs, median 90th/95th percentile rates were norepinephrine 14.0/18.3 μg/min and phenylephrine 60/80 μg/min.
Conclusions:
- Establishing alarm settings based on percentile limits ensures predictable alarm frequency (e.g., 95th percentile triggers 1 in 20 times).
- Institutions can adopt standardized alarm settings using validated usage data, improving infusion pump safety.
- Further research is needed to determine optimal percentile values for alarm settings.