The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

ANALYSIS of ventilator Alarms Found out of standard in a children’s hospital

Peter Betit RRT, Michelle Lilley RRT, John Thompson RRT, John Arnold MD. Children’s Hospital and Harvard Medical School, Boston, MA

Background: Evaluating ventilator alarm function is an important component of ensuring safe mechanical ventilation. We evaluate ventilator alarm function as part of a periodic safety check conducted on all mechanically ventilated patients in 3 ICUs, [neonatal (NICU), med-surg (MSICU), and cardiac (CICU)], representing 64 beds. All ventilator alarms are set to a department standard. We report the analysis of ventilator alarms found out of standard monitored prospectively over a 5-year period.

Methods:
A ventilator complication report was completed by RTs at the end of each shift. Ventilator patients, ventilator days, alarms found out of standard (AOS), and alarms found out of standard / 1000 ventilator hours (AOS/1K) were recorded and evaluated from 10/99 to 09/03.

Results:
There were 10,847 ventilator patients; 1890 NICU, 5284 CICU, and 3673 MSICU; and 55,122 ventilator days. Overall there were 198.8 ± 51.6 AOS and 1.00 ± 0.37 AOS/1K. The AOS/year were NICU 37.8 ± 12.0, CICU 43.4 ± 3.8, and MSICU 120.2 ± 14.0. The AOS/1K /year were NICU 0.6 ± 0.3, CICU 0.4 ± 0.8, and MSICU 1.3 ± 0.7.


Conclusions: The AOS were highest in the MSICU and lowest in the NICU. We attribute the differences in AOS between ICUs to the various patient populations, and the brand of ventilator used. The relatively low AOS rate in the NICU may in part be due to the population of pre-term infants who are typically maintained on minimal ventilator support until weight targets are attained, and require minimal alarm adjustments. The downward trend of AOS in the NICU in the last 2 years may be due to the introduction of a new ventilator that auto-adjusts minute ventilation alarms. The CICU tends to consist of a more homogenous population of postoperative patients who are weaned and extubated by protocol in an expeditious manner, and as a result require fewer alarm adjustments. The MSICU patient population tends to be less homogeneous with a variety of medical and surgical diagnoses, and requires more refinements in ventilator modes, settings and alarms. The patients’physiologic conditions are more dynamic, and as their condition improves, alarms may become out of standard between safety checks. The evaluation of AOS is part of our ongoing ventilator complication QI program and consistent with JCAHO safety goals. Comparing AOS rates with similar institutions may help determine an acceptable rate of AOS.

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