Tan Wei, Sun Long-feng, Qin Zheng, Dai Bing, Zhao Hong-wen, Kang Jian
Department of Medical Intensive Care Unit, the First Hospital of China Medical University, Shenyang, Liaoning, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Oct;24(10):582-6.
To analyze the common reasons of invasive ventilator alarms between medical intensive care unit (ICU) and specialist ICU, and its related management methods.
Patients admitted to medical ICU and specialist ICU from January to December in 2011 of the First Hospital of China Medical University were studied. Ventilator alarms and their reasons need to be handle by the front-line doctors, respiratory therapists, attending physicians or medical ICU doctors were analyzed and compared.
There were 375 ventilator alarms of the 59 patients in the medical ICU, incidence of the top three alarms parameters were high airway pressure alarms for 21.87%, high tide volume alarms for 15.73% and high minute ventilation alarms for 14.13%. In specialist ICU there were a total of 403 ventilator alarms with 249 patients, incidence of the top three alarms parameters were high airway pressure alarms for 32.51%, low airway pressure alarms for 15.38%, high respiratory rate alarms for 10.42%. The incidence of high airway pressure and low airway pressure alarms in medical ICU were significantly lower than the specialist ICU (21.87% vs. 32.51%, 8.53% vs. 15.38%, both P<0.01), and the incidence of high minute ventilation and high tidal volume alarms in medical ICU were higher than specialist ICU (14.13% vs. 7.20%, 15.73% vs. 9.68%, P<0.01 and P<0.05). The top three causes of the alarms were aerosol inhalation, sputum blockage, and oxygen battery expired in medical ICU, and sputum blockage, respiratory distress, and pipeline leak and oxygen expired battery in specialist ICU. The reasons of sputum blockage, tubes factors (intubation position change, pipeline water) and improper alarm parameters setting in medical ICU was significantly lower than those in specialist ICU (10.93% vs. 17.12%, 1.87% vs. 4.47%, 1.33% vs. 3.72%, 1.60% vs. 3.97%, all P<0.05). High tidal volume, high minute ventilation and serious breath-side filter blockage because of aerosol inhalation in medical ICU were significantly higher than those in specialist ICU (18.93% vs. 3.97%, P<0.01).
Doctors in medical ICU and specialist ICU should understand the ventilator alarms characteristics, prevention, detect and timely problems management.
分析内科重症监护病房（ICU）与专科ICU有创呼吸机报警的常见原因及其相关管理方法。
对中国医科大学附属第一医院2011年1月至12月收治入内科ICU和专科ICU的患者进行研究。分析并比较一线医生、呼吸治疗师、主治医师或内科ICU医生需要处理的呼吸机报警及其原因。
内科ICU的59例患者共发生375次呼吸机报警，报警参数发生率排名前三的是气道高压报警占21.87%、潮气量过高报警占15.73%、分钟通气量过高报警占14.13%。专科ICU的249例患者共发生403次呼吸机报警，报警参数发生率排名前三的是气道高压报警占32.51%、气道低压报警占15.38%、呼吸频率过高报警占10.42%。内科ICU气道高压和气道低压报警的发生率显著低于专科ICU（21.87% 对32.51%，8.53% 对15.38%，均P<0.01），内科ICU分钟通气量过高和潮气量过高报警的发生率高于专科ICU（14.13% 对7.20%，15.73% 对9.68%，P<0.01和P<0.05）。内科ICU报警的前三位原因是雾化吸入、痰液堵塞、氧电池过期，专科ICU是痰液堵塞、呼吸窘迫、管路漏气和氧电池过期。内科ICU痰液堵塞、管路因素（插管位置改变、管路积水）及报警参数设置不当的原因显著低于专科ICU（10.93% 对17.12%，1.87% 对4.47%，1.33% 对3.72%，1.60% 对3.97%，均P<0.05）。内科ICU因雾化吸入导致的潮气量过高、分钟通气量过高及呼吸侧过滤器严重堵塞显著高于专科ICU（18.93% 对3.97%，P<0.01）。
内科ICU和专科ICU的医生应了解呼吸机报警特点、预防、检测及及时处理问题。
