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  • %0 ART
  • %T Poor prognosis for existing monitors in the intensive care unit
  • %A TSIEN C. L.
  • %A FACKLER J. C.
  • %G 0090-3493
  • %I Lippincott Williams & Wilkins
  • %C Hagerstown, MD, ETATS-UNIS
  • %D 1997
  • %V 25
  • %N 4
  • %P 614-619
  • %O Anglais
  • %K Instrumentation
  • %K Appareillage
  • %K Alarm
  • %K Alarme
  • %K Monitoring
  • %K Monitorage
  • %K Intensive care unit
  • %K Unité soin intensif
  • %K Performance evaluation
  • %K Evaluation performance
  • %K Human
  • %K Homme
  • %K Intensive care
  • %K Soin intensif
  • %X 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. 
  • %S Critical care medicine