Frequency, Rate and Cause of Ventilator Alarms in a Pediatric Intensive Care Setting

Background: Clinical alarms play an important part in monitoring patient’s vital signs in the hospital intensive care environment. However, when non-actionable alarms go off too frequently, the opposite may occur and patients can be placed at increased risk of harm due to alarm fatigue. Delays in staff response to alarms are well documented as healthcare givers become desensitized to increased rates of nuisance alarms. Current literature suggests alarms originating from ventilators contribute significantly to the total number of non-actionable alarms. A greater understanding of which specific ventilator alarms are most common and the rates at which they occur is fundamental to improved management of ventilator alarms. Methods: A retrospective review was performed on ventilator alarm occurrences for two common types of ventilators used in the pediatric intensive care (PICU) and pediatric cardio-thoracic intensive care (CTICU) units between June 1, 2017 and November 31, 2017, at a major metropolitan children’s hospital. Data collected included alarm data for the Avea and Servo-I ventilators. Descriptive data analysis was performed using Matlab to identify characteristics such as prevalence, proportionality and cause. Results: Eleven types of medium and high priority ventilator alarms were identified as common in the PICU and CTICU during 2,091 days of mechanical ventilation. The Inspiratory Flow Overrange (36.6%) on the Servo-I ventilator was the most common cause for ventilator alarms. Medium priority alarms comprised more than 54% of all alarms activated. The combined PICU and CTICU incidence rate of ventilator alarms was 0.94 alarms per ventilator-hour. Conclusions: Ventilator alarms occur frequently in the pediatric ICUs and rates vary considerably between the different types of alarms. More than half of all the alarms generated were due to two types of medium priority alarms. Alarm reduction strategies must target the most common types of alarms.