| Abstrakt: |
Background: Alarm fatigue is a growing concern in the health care arena and is associated with morbidity and mortality. The Joint Commission established alarm management as a Hospital National Patient Safety Goal. We sought to determine how ventilator alarms are set related to measured patient values. Methods: Retrospective data was gathered manually from the electronic medical record. The data included gender, height, ICU, shift, ventilator mode, measured exhaled VT, and peak airway pressure (Ppeak), also alarm limits for VT and Ppeak were recorded. We chose to focus on the high VT and Ppeak limits which might be considered important in providing lung protection. For the VT limit analysis, we expressed the limit in mL/kg of PBW. For the Ppeak limit analysis we determined three levels, <15 cmH2O, 15 -25 cm H2O, and >25 cm H2O. Data was collected and summarized in Excel and processed using SPSS. Results: Data from 45 patients was obtained representing 134 total samples, and 6 ICUs. The ventilators included the Draeger V-500 (97), Puritan Bennett 840 (33), Carefusion AVEA (2) and Respironics LTV (2). The Ppeak limits were set at 40 cm H2O 25% of the time, at 45 cm H2O 18%, at 49 cmH2O 2%, at 50 cm H2O 48% of the time, >50 in 7%. 90% of Ppeak limits were set >15 cm H2O above the actual Ppeak and 40% were set >25 cm H2O above, regardless of mode or breath type. 60% of CPAP/PS alarms were set >25 cm H2O above actual Ppeak. The VT limits were set to 1000 mL 75% of the time and 35% of these represented a volume >15 mL/kg. When set to >1000 mL, 100% of time this was >15 mL/kg. More than 95% of limits were set >12 mL/kg and >42% were set to >15 mL/kg, regardless of mode or breath type. Limitations: Limitations include the small sample size and focusing only on specific alarm limits. Conclusions: The Ppeak high limits were set substantially above Ppeak. When adjusting the limit to accommodate a procedure, such as a recruitment maneuver, it is important to readjust it back down. It is important to monitor VT especially in pressure ventilation, yet about 50% of alarms were set >15mL/kg. Interventions and education of staff will be pursued and a follow up study completed. Disclosures: We have no financial or other conflicts of interest to disclose. [ABSTRACT FROM AUTHOR] |
