2011 OPEN FORUM Abstracts
MECHANICAL VENTILATOR ALARMS: WILL THEY EVER GO OFF?
Ruben D. Restrepo1,2, Taha T. Ismaeil2, Mansour Al Alaiwah2, Adil Al-Otaibi2; 1Respiratory Care, UTHSCSA, San Antonio, TX; 2Respiratory Care, King Saud Abdulaziz University - Health Sciences, Riyadh, Saudi Arabia
Background: Ventilator alarms are a critical component of patient's care and safety in the ICU. The presence of almost 40% ICU false negative alarm events can be overwhelming and cause either alarm desensitization of clinicians or laxity on the way the alarms are set, or both. Unfortunately, these actions lead to lack of response to real event or a dramatic reduction on the number of alarm events since the limits are simply too hard to reach even in situations when the patient is seriously decompensated. There is very limited data on how RTs set the alarm limits for patients in the ICU. We wanted to evaluate how these limits deviate from both the observed ventilator parameters and from the recommended limits in adult ICUs. Methods: Prospective observational study at a university-affiliated, 1000-bed hospital in Riyadh, Saudi Arabia. We collected data in a total of 8 adult ICUs. Respiratory therapy students, under direct supervision of faculty and staff, recorded high (Hi) and low (Lo) alarm settings for all mechanically ventilated patients in the ICUs (n= 31) during the first ventilator check of day shift. The alarm settings selected for analysis were high respiratory rate (Hi RR), high peak inspiratory pressure (Hi PIP), and high and low minute volume (Hi MV, Lo MV), as they represent the most commonly monitored alarms. Results: The mean value recorded for the observed parameters was: RR 23.3 (SD 6.1) breaths/min; PIP 24.9 (SD 6.8) cm H2O; MV 9.9 (SD 2.5) L/min. Every alarm limit recorded was significantly distant from the observed parameter (range: 90%-136%). When a 40% alarm limit above and below the observed parameter was selected, the percent deviation from this new limit ranged between 38% (Hi PIP) and 96% (Lo MV). Conclusion: Ventilator alarm settings in our study were in complete disconnection with the observed parameters or any recommended limits on patients receiving mechanical ventilation. Although false alarms can clearly affect efficiency in the ICU environment, it is critical that alarm limits are set appropriately to detect changes in patient's condition that may require intervention. Future Direction: As part of a quality and improvement project, RT students from KSAUH will present this data to the RT department at National Guard Health Affairs and will conduct a follow-up study 3 months later. Sponsored Research - None