Can You Hear the Beep? Selecting the Best Ventilator Alarm Parameters in the ICU

Abstract

Background:

Patient safety plays a vital role in health care. The AARC has recommended protocols to standardize patient care and improve outcomes. In the critical care setting, ventilator alarms are essential to ensure patient safety while undergoing mechanical ventilation. While there are not evidence-based standards for selecting ventilator alarms, some institutions have arbitrarily adopted a 50% higher and lower than patient’s recorded value on the patient-ventilator assessment. The goal of this study was to evaluate alarm parameter selection practices in one adult medical ICU at a large metropolitan city in Texas.

Methods:

This prospective observational study was conducted at a university-affiliated hospital in San Antonio. Patients 18 years old and older who were mechanically ventilated in adult ICUs were included in this study. The respiratory rate (RR), peak inspiratory pressure (PIP), tidal volume (V_T), and minute ventilation (VE) documented in the patient-ventilator assessment were compared with the selected alarm parameters (high RR, high pressure alarm, high V_T, and high/low VE). Excel (Microsoft) was used to collect data. Descriptive statistics were used to report the results.

Results:

One-hundred and twenty-five subjects participated in this study. Most participants were male (61%) and their mean age was 53.6 years (± 14.9; range 18-100). The mean exhaled V_T for the subjects was 396.86 mL (± 139.93), while the mean high V_T alarm was set 99.7% higher (792.44 mL ± 214.5). The mean PIP was 22.76 cm H₂O (± 7.48 cm H₂O), whereas the mean high-pressure alarm was set 76.3% higher (40.12 ± 4.64 cm H₂O). While the mean VE was 7.92 L/min (± 3.00 L/min), the mean high VE alarm set was 113.9% higher (16.94 ± 4.03 L/min) and the mean low VE alarm was 43.5% below the patient recorded VE (2.86 ± 2.61 L/min). The mean RR by the patients was 21.90 breaths/min, while the mean high RR alarm set was 94.9% higher (42.69 breaths/min ± 9.04).

Conclusions:

Based on these results, the ventilator alarms selected by respiratory therapists in this ICU, except for the low VE, were set well outside of recommended ranges. This practice needs further evaluation and standardization as it may compromise patient safety.