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Prevalence, Proportionality, and Cause of Ventilator Alarms in a Pediatric Intensive Care Setting
Leo Langga1,2, Jisoo Oh2, David López3
1Department of Respiratory Care, Children's Hospital Los Angeles, Los Angeles, California. leolangga@gmail.com.
Insights
Ventilator alarms in pediatric ICUs frequently occur, with specific types varying by device. Understanding these alarm patterns is key to reducing patient risk from alarm fatigue.
Area of Science:
- Critical Care Medicine
- Biomedical Engineering
- Patient Safety
Background:
- Clinical alarms are crucial in intensive care but contribute to alarm fatigue.
- Ventilator alarms are a significant source of nonactionable alerts.
- Understanding specific ventilator alarm prevalence is essential for effective management.
Purpose of the Study:
- To analyze the prevalence and causes of ventilator alarms in pediatric intensive care units.
- To compare alarm data between different ventilator models (Avea and Servo-i).
- To identify the most common high- and medium-priority alarms.
Main Methods:
- Retrospective review of alarms from Avea and Servo-i ventilators.
- Data collected from pediatric ICU and cardiothoracic ICU between June and November 2017.
- Descriptive analysis and 2-proportion z-test used to determine alarm rates and significance.
Main Results:
- Eleven distinct alarms were identified over 2,091 ventilator-days.
- Inspiratory Flow Overrange (Servo-i) and Low VTE (Avea) were most prevalent.
- Alarm prevalence was 22.5 alarms per ventilator-day; rates differed significantly between ICUs (P < .001).
Conclusions:
- Ventilator alarm types and proportions differ by device and care unit.
- High-priority alarms were more common on Avea, medium-priority on Servo-i.
- The study highlights the need for tailored alarm management strategies based on specific ventilator and unit data.
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-priority 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 proportionality, 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 between both areas (P < .001). The overall alarm prevalence rate was 22.5 ventilator alarms per ventilator-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.
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