Physiologic monitor alarms for children: Pushing the limits

Thoracic Impedance Pneumography-Derived Respiratory Alarms and Associated Patient Characteristics

BACKGROUND

Respiratory rate (RR) alarms alert clinicians to a change in a patient's condition. However, RR alarms are common occurrences. To date, no study has examined RR alarm types and associated patient characteristics, which could guide alarm management strategies.

OBJECTIVES

To characterize RR alarms by type, frequency, duration, and associated patient demographic and clinical characteristics.

METHODS

A secondary data analysis of alarms generated with impedance pneumography in 461 adult patients admitted to either a cardiac, a medical/surgical, or a neurological intensive care unit (ICU). The RR alarms included high parameter limit (≥30 breaths/min), low parameter limit (≤5 breaths/min), and apnea (no breathing ≥20 s). The ICU type; total time monitored; and alarm type, frequency, and duration were evaluated.

RESULTS

Of 159 771 RR alarms, parameter limit alarms (n = 140 975; 88.2%) were more frequent than apnea alarms (n = 18 796; 11.8%). High parameter limit alarms were most frequent (n = 131 827; 82.5%). After ICU monitoring time was controlled for, multivariate analysis showed that alarm rates were higher in patients in the cardiac and neurological ICUs (P = .001), patients undergoing mechanical ventilation (P = .005), and patients without a ventricular assist device or pacemaker (P = .02). Male sex was associated with low parameter limit (P = .01) and apnea (P = .005) alarms.

CONCLUSION

High parameter limit RR alarms were most frequent. Factors associated with RR alarms included monitoring time, ICU type, male sex, and mechanical ventilation. Although these factors are not modifiable, these data could be used to guide management strategies.