Lawless S T
Department of Pediatrics and Anesthesia, Alfred I. duPont Institute, Wilmington, DE 19899.
Crit Care Med. 1994 Jun;22(6):981-5.
To determine the predictive value of patient monitoring alarms as a warning system in a pediatric intensive care unit (ICU).
Prospective, observational study.
Pediatric ICU of a university affiliated children's hospital.
During a 7-day period, ICU staff were asked to record the type and number of alarm soundings. Alarms were recorded as false, significant (resulted in change in therapy), or induced (by staff manipulations; not significant).
Sixty-six percent of nursing shifts (928 patient hours of care) responded. There were 2,176 alarms soundings: 1,481 (68%) false, 119 (5.5%) significant, and 576 (26.5%) induced. Alarm origins were: 44% pulse oximeter, 1% end-tidal PCO2, 31% ventilator, and 24% electrocardiograph (EKG). The positive predictive value of alarms were: 7% pulse oximeter, 16% end-tidal PCO2, 3% ventilator, and 5% EKG. The negative predictive value of all alarms were > 97%. More alarms sounded during the 7:00 am to 3:00 pm shift than during the 3:00 pm to 11:00 pm or 11:00 pm to 7:00 am shifts (167 +/- 19 vs. 64 +/- 39 vs. 75 +/- 43, p < .05, respectively). When corrected for number of patients/shift, the occurrence of soundings differed only between day and night (11.4 +/- 1.5/patient/shift vs. 6.1 +/- 1.0, p < .05).
Over 94% of alarm soundings in a pediatric ICU may not be clinically important. Present monitoring systems are poor predictors of untoward events.
确定患者监测警报作为儿科重症监护病房（ICU）预警系统的预测价值。
前瞻性观察研究。
一所大学附属医院的儿科ICU。
在7天的时间里，要求ICU工作人员记录警报响起的类型和次数。警报被记录为误报、重大警报（导致治疗改变）或诱发警报（由工作人员操作引起；不重大）。
66%的护理班次（928个患者护理小时）做出了回应。共响起2176次警报：1481次（68%）为误报，119次（5.5%）为重大警报，576次（26.5%）为诱发警报。警报来源为：44%来自脉搏血氧仪，1%来自呼气末二氧化碳分压，31%来自呼吸机，24%来自心电图（EKG）。警报的阳性预测值分别为：脉搏血氧仪7%，呼气末二氧化碳分压16%，呼吸机3%，心电图5%。所有警报的阴性预测值均>97%。上午7点至下午3点班次响起的警报比下午3点至晚上11点或晚上11点至上午7点班次更多（分别为167±19次 vs. 64±39次 vs. 75±43次，p<.05）。当校正每班患者数量后，警报响起次数仅在白天和夜间存在差异（每班每患者11.4±1.5次 vs. 6.1±1.0次，p<.05）。
儿科ICU中超过94%的警报响起可能在临床上并不重要。目前的监测系统对不良事件的预测能力较差。
