一种临床呼吸机警报管理方法对重症监护护士警报疲劳的影响：一项随机对照试验。

The effect of a clinical approach to ventilator alarm management on alarm fatigue in intensive care nurses: a randomized controlled trial.

作者信息

Nasirmoghadas Amirhossein, Salimi Akinabadi Atefe, Rahimi Yekta, Sanaie Neda, Sedighi Ladan

机构信息

Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.

出版信息

BMC Nurs. 2025 Jul 1;24(1):815. doi: 10.1186/s12912-025-03500-3.

DOI:10.1186/s12912-025-03500-3

PMID:40598512

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12210660/

Abstract

BACKGROUND

Every day in intensive care units (ICUs), many alarms from several devices -especially ventilators- are generated, creating a noisy environment, which is on the top of technology-related hazards and may lead to alarm fatigue among nurses. This study aimed to investigate the impact of a clinical approach to ventilator alarm management on nurses' alarm fatigue and alarm frequency in ICUs.

METHODS

This randomized controlled trial involved 75 nurses in two general ICUs allocated into control and intervention groups using cluster randomization. In the intervention group (IG), clinical causes and solutions of common ventilator alarms were trained in a 4-hour online webinar. Then, an evidence-based guideline for alarm management was attached to all ventilators in the intervention ICU. Additionally, nurses of the IG were trained virtually and face-to-face regarding the fundamentals of mechanical ventilation and how to manage ventilator alarms for one month. Before and after the intervention, nurses' alarm fatigue and frequency of three common alarms were recorded for five consecutive days. The control group (CG) did not receive the educational content. Data were analyzed using SPSS-26. This study adheres to CONSORT guidelines.

RESULTS

The baseline characteristics were not significantly different between the groups. Also, alarm fatigue scores of nurses did not significantly differ between groups before the intervention (p = 0.17). In the IG, nurses' alarm fatigue scores significantly decreased from 24.86 ± 6.65 to 20.24 ± 4.39 (p < 0.025) and its difference was significant between the groups (p < 0.001). However, alarm fatigue scores in the CG did not improve significantly after one month. As a secondary outcome, the frequency of three common alarms including high pressure (-34.3%), high minute volume/tidal volume (-28.6%), and high respiratory rate (-25.4%) was reduced after the intervention.

CONCLUSION

This study indicated that training and implementing an evidence-based clinical approach to ventilator alarm management not only reduced nurses' alarm fatigue but also could lead to a significant reduction in the common ventilator alarms frequency.

TRIAL REGISTRATION

This study was prospectively registered by the Iranian Registry of Clinical Trials ( https://irct.behdasht.gov.ir/ ) on 01/09/2024 with registration ID: IRCT20240306061197N2.

摘要

背景

在重症监护病房（ICU），每天都会有来自多种设备（尤其是呼吸机）的许多警报响起，营造出嘈杂的环境，这是技术相关危害之外的问题，还可能导致护士出现警报疲劳。本研究旨在探讨一种临床方法用于呼吸机警报管理对ICU护士警报疲劳和警报频率的影响。

方法

这项随机对照试验纳入了两个综合ICU的75名护士，采用整群随机化的方式将她们分为对照组和干预组。在干预组（IG）中，通过4小时的在线网络研讨会对常见呼吸机警报的临床原因及解决方法进行了培训。然后，将基于证据的警报管理指南附在干预ICU的所有呼吸机上。此外，对干预组的护士就机械通气的基本原理以及如何管理呼吸机警报进行了为期一个月的线上和面对面培训。在干预前后，连续五天记录护士的警报疲劳情况以及三种常见警报的频率。对照组（CG）未接受教育内容。使用SPSS - 26对数据进行分析。本研究遵循CONSORT指南。

结果

两组的基线特征无显著差异。而且，干预前两组护士的警报疲劳评分也无显著差异（p = 0.17）。在干预组中，护士的警报疲劳评分从24.86 ± 6.65显著降至20.24 ± 4.39（p < 0.025），且两组间差异显著（p < 0.001）。然而，对照组的警报疲劳评分在一个月后未显著改善。作为次要结果，干预后包括高压（-34.3%）、高分钟通气量/潮气量（-28.6%）和高呼吸频率（-25.4%）在内三种常见警报频率降低。