Intensive care unit alarms-How many do we need?
Intensive care unit alarms-How many do we need?
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DOI：
10.1097/ccm.0b013e3181cb0888
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发表时间：
2010-02-01
影响因子：
8.8
通讯作者：
Wrede, Christian E.
中科院分区：
文献类型：
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作者：
Siebig, Sylvia;Kuhls, Silvia;Wrede, Christian E.
目的：通过生成生理数据和临床警报注释数据库，在实验环境中验证危重患者的心血管警报，并报告当前警报发生率及其临床有效性。目前，危重病人的生理参数监测是通过报警系统进行的，灵敏度高，但特异性低。结果，产生了大量对护理质量有潜在负面影响的警报。设计：前瞻性、观察性、临床研究。设置：大学医院的重症监护病房。数据来源：2006 年 1 月至 2007 年 5 月期间收集的不同医疗重症监护病房患者的数据。测量和主要结果：从监测网络中提取 1 秒间隔的生理数据、监视器警报和警报设置。由经验丰富的医生对视频记录的警报相关性和技术有效性进行了注释。在 982 小时的观察期间，注释了 5934 个警报，相当于每小时 6 个警报。大约 40% 的警报未能正确描述患者状况，并被归类为技术错误警报；其中 68% 是由操纵造成的。所有警报中只有 885 个 (15%) 被认为具有临床相关性。大多数生成的警报都是阈值警报 (70%)，并且与动脉血压相关 (45%)。 结论：这项研究使用了一种基于视频的离线医师注释的新方法，表明即使使用现代监测系统，大多数警报也与临床无关。由于大多数警报都是简单的阈值警报，因此统计方法可能适合帮助减少误报警报的数量。我们的研究还旨在开发一个带注释的监控警报的参考数据库，以进一步应用于警报算法研究。 （《重症监护医学》2010 年；38：451-456）
Objective: To validate cardiovascular alarms in critically ill patients in an experimental setting by generating a database of physiologic data and clinical alarm annotations, and report the current rate of alarms and their clinical validity. Currently, monitoring of physiologic parameters in critically ill patients is performed by alarm systems with high sensitivity, but low specificity. As a consequence, a multitude of alarms with potentially negative impact on the quality of care is generated.Design: Prospective, observational, clinical study.Setting: Medical intensive care unit of a university hospital.Data Source: Data from different medical intensive care unit patients were collected between January 2006 and May 2007.Measurements and Main Results: Physiologic data at 1-sec intervals, monitor alarms, and alarm settings were extracted from the surveillance network. Video recordings were annotated with respect to alarm relevance and technical validity by an experienced physician. During 982 hrs of observation, 5934 alarms were annotated, corresponding to six alarms per hour. About 40% of all alarms did not correctly describe the patient condition and were classified as technically false; 68% of those were caused by manipulation. Only 885 (15%) of all alarms were considered clinically relevant. Most of the generated alarms were threshold alarms (70%) and were related to arterial blood pressure (45%).Conclusion: This study used a new approach of off-line, video-based physician annotations, showing that even with modern monitoring systems most alarms are not clinically relevant. As the majority of alarms are simple threshold alarms, statistical methods may be suitable to help reduce the number of false-positive alarms. Our study is also intended to develop a reference database of annotated monitoring alarms for further application to alarm algorithm research. (Crit Care Med 2010; 38:451-456)