Titre du document / Document title

Poor prognosis for existing monitors in the intensive care unit

Auteur(s) / Author(s)

TSIEN C. L. ⁽¹⁾ ; FACKLER J. C. ⁽²⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ MIT Laboratory for Computer Science, Harvard-Masachusetts Institute of Technology, Division of Health Sciences and Technology, Cambridge, MA, ETATS-UNIS
⁽²⁾ Children's Hospital, Harvard Medical School, Boston, MA, ETATS-UNIS

Résumé / Abstract

Objective: To identify areas requiring the most urgent improvement in the intensive care unit (ICU); and to accurately determine the positive predictive value of routine critical care patient monitoring alarms, as well as the common causes for false-positive alarms. Design: Prospective, observational study. Setting: A multidisciplinary ICU in a university-affiliated children's hospital (excluding children with primary heart disease). Interventions: The occurrence rate, cause, and appropriateness of all alarms from tracked monitors were recorded by a trained observer and validated by the bedside nurse over a 10-wk period for a single bedspace at a time. Measurements and Main Results: After 298 monitored hrs, 86% of a total 2,942 alarms were found to be false-positive alarms, while an additional 6% were classified as clinically irrelevant true alarms. Only 8% of all alarms tracked during the study period were determined to be true alarms with clinical significance. Alarms were also classified according to whether they were clearly associated with a patient intervention (18%), were clearly not associated with a patient intervention (74%), or had unclear association to interventions (8%). While 11% of nonpatient intervention alarms were clinically significant true alarms, only 2% of patient intervention alarms were so. Positive predictive values for the various devices ranged from <1% for the pulse oximeter's heart rate signal to 74% for the arterial catheter's mean systemic blood pressure signal during periods free from patient interventions. The pulse oximeter caused false-positive alarms most frequently, with common reasons being bad data format/bad connection and poor contact. Conclusion: Efforts to develop intelligent monitoring systems have more potential to deliver significantly improved patient care by initially targeting especially weak areas in ICU monitoring, such as pulse oximetry reliability.

Revue / Journal Title

Critical care medicine   ISSN 0090-3493   CODEN CCMDC7 

Source / Source

1997, vol. 25, n^o4, pp. 614-619 (21 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott, Hagerstown, MD, ETATS-UNIS  (1973) (Revue)

Mots-clés anglais / English Keywords

Instrumentation ; Alarm ; Monitoring ; Intensive care unit ; Performance evaluation ; Human ; Intensive care ;

Mots-clés français / French Keywords

Appareillage ; Alarme ; Monitorage ; Unité soin intensif ; Evaluation performance ; Homme ; Soin intensif ;

Mots-clés espagnols / Spanish Keywords

Instrumentación ; Alarma ; Monitoreo ; Unidad terapia intensiva ; Evaluación prestación ; Hombre ; Cuidado intensivo ;

Localisation / Location

INIST-CNRS, Cote INIST : 17751, 35400006533781.0100