Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117, Berlin, Germany.
Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA.
Sci Rep. 2022 Dec 16;12(1):21801. doi: 10.1038/s41598-022-26261-4.
Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15-5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16-1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19-1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10-1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13-1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18-1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13-1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.
重症监护病房（ICU）经常被监测设备的警报淹没，这对医护人员和患者都构成了危险。迄今为止，针对过度监测警报的建议解决方案仍停留在研究层面。我们旨在确定影响 ICU 警报率的患者特征，目的是提出一种简单的解决方案，可以轻松地在 ICU 中实施。在德国柏林的一家三级护理大学医院的 8 个成人 ICU 中，回顾性地收集了 2019 年 9 月至 2021 年 3 月之间的警报日志。纳入至少 24 小时连续警报日志的 ICU 成人患者。每位患者每天的警报总数进行了计算。中位数为 119。共纳入了 3205 名患者的 26890 次观察。从患者的电子健康记录（EHR）中提取了 23 个变量，并进行了多变量逻辑回归，以评估患者特征与警报率之间的关联。有创血压监测（调整后的优势比（aOR）4.68，95%CI 4.15-5.29，p<0.001）、有创机械通气（aOR 1.24，95%CI 1.16-1.32，p<0.001）、心力衰竭（aOR 1.26，95%CI 1.19-1.35，p<0.001）、慢性肾衰竭（aOR 1.18，95%CI 1.10-1.27，p<0.001）、高血压（aOR 1.19，95%CI 1.13-1.26，p<0.001）、高 RASS（aOR 1.22，95%CI 1.18-1.25，p<0.001）和计划手术入院（aOR 1.22，95%CI 1.13-1.32，p<0.001）与高警报率显著相关。我们的研究表明，应将特定于患者的警报管理纳入 ICU 的临床常规中。为了降低整体警报负荷，对于接受有创血压监测、有创机械通气、心力衰竭、慢性肾衰竭、高血压、高 RASS 或计划手术入院的患者，尤其应注意警报管理，因为它们更有可能对噪音污染、警报疲劳产生高贡献，从而危及 ICU 中的患者安全。
