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Degree of Discrepancy Between Ventilator Alarm Settings and Patient Parameters in the PICU FREE TO VIEW

Lorena Fernandez-Restrepo, MD; Minnette Son, MD; Ruben Restrepo, RRT; Marcos Restrepo, MD
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University of Texas Health Science Center, San Antonio, TX

Chest. 2014;146(4_MeetingAbstracts):517A. doi:10.1378/chest.1991782
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SESSION TITLE: Outcomes/Quality Control Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The objective of this quality improvement study was to evaluate mechanical ventilator alarms selection in pediatric patients admitted to the ICU. Our primary aim was to determine the degree of discrepancy between ventilator alarm settings and some of the routinely monitored respiratory parameters in the PICU.

METHODS: This was a retrospective cohort study conducted in an academically affiliated medical-surgical PICU during a six-month period. The alarm settings selected for analysis were high respiratory rate (HiRR), high peak inspiratory pressure (HiPIP), and high and low minute volume (HiMV, LoMV), as they represent the most frequently monitored and documented alarms in the ventilator flow sheet.

RESULTS: Ventilator patient parameters and alarm settings documented on the ventilator flow sheet of 64 patients admitted to the PICU were used for analysis. The overall mean discrepancy between the selected ventilator alarm value and the actual patient parameters was 119.4%. The alarm setting that appeared to be more distantly set from the patient parameter was the HiMV [154.5%; IQR 25%-75% (54.8, 197.1)], followed by the HiRR [147.7%; IQR 25%-75% (98%,183.7%)], HiPIP [113.6%; IQR 25%-75% (74.2%, 133.3%)], and LoMV [61.8%; IQR 25%-75% (47.9%, 75.2%)].

CONCLUSIONS: Our data demonstrates that there is very important discrepancy between ventilator alarms and the measured patient parameters. Although how this practice may impact clinical outcomes and patient safety has not been well investigated, it should be seriously evaluated. Future quality improvement strategies should focus on determining the best and safest practice for selecting and adjusting ventilator alarms.

CLINICAL IMPLICATIONS: While ventilator alarms are designed to alert clinicians of important deviation of respiratory patient parameters, they are also known to cause distraction, noise, stress, and fatigue. They should be individually set and adjusted; however, observations of alarm selection do not appear to support this recommended practice. This practice is due in part to the high incidence of false alarms and alarm fatigue, which has lead clinicians to broaden alarm parameters. In addition, no specific clinical guidelines have been published to recommend alarm selection. Previous reports in adults have shown that ventilator alarms are routinely set far from patient parameters; however, no report exists regarding such behavior in the pediatric population.

DISCLOSURE: The following authors have nothing to disclose: Lorena Fernandez-Restrepo, Minnette Son, Ruben Restrepo, Marcos Restrepo

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