Prevalence, Proportionality, and Cause of Ventilator Alarms in a Pediatric Intensive Care Setting.

BACKGROUND: Clinical alarms play an important role in monitoring physiological parameters, vital signs and medical device function in the hospital intensive care environment. Delays in staff response to alarms are well documented as health care providers become desensitized to increased rates of nuisance alarms. Patients can be at increased risk of harm due to alarm fatigue. Current literature suggests alarms from ventilators contribute significantly to nonactionable alarms. A greater understanding of which specific ventilator alarms are most common and the rates at which they occur is fundamental to improving alarm management. METHODS: A retrospective review was performed on alarms that occurred on the Avea and Servo-i ventilators used in the pediatric ICU and pediatric cardiothoracic ICU at a major metropolitan children's hospital. High- and medium-priority alarms, as classified by the manufacturer, were studied between June 1, 2017, and November 31, 2017. Descriptive data analysis and a 2-proportion z-test were performed to identify proportionality, cause, and prevalence rates in the pediatric ICU and the cardiothoracic ICU. RESULTS: Eleven distinct ventilator alarms were identified during 2,091 d of mechanical ventilation. The Inspiratory Flow Overrange alarm (42.4%) on the Servo-i, Low VTE (20.4%; expiratory tidal volume) and Circuit Integrity alarm (20.0%) on the Avea were the most prevalent causes according to ventilator type. Medium-priority alarms comprised 68.7% of all Servo-i alarms, and high-priority alarms comprised 84% of all Avea alarms. The 2-sample test of proportions was significant for differences between both areas (P < .001). The overall alarm prevalence rate was 22.5 ventilator alarms per ventilator-day per patient. CONCLUSIONS: The cause and proportion of alarms varied by ventilator and care unit. High-priority alarms were most common with the Avea and medium-priority alarms for the Servo-i. The overall combined ventilator alarm prevalence rate was 22.5 alarms per ventilator-day per patient.

Risk factor profiles among intravenous drug using young adults: a latent class analysis (LCA) approach.

Using data from a cross-sectional study that examined health risk behaviors among urban intravenous drug-using (IDU) adolescents and young adults, this study investigated risk profiles among a high-risk sample (n=274). Risk profiles were empirically derived through latent class analysis based on indicators of engagement in health-risking behaviors, experience of abuse and violence as well as individual and family risk factors. The best fitting model was a 3-class model. Class 1 (n=95) captured participants with the lowest risk across all indicators. Compared to Class 1, Class 2 (n=128) and Class 3 (n=51) had elevated rates of engagement in health-risking behaviors as well as individual and family risk factors; however, Class 3 had the highest rate of engagement in sexual risk behavior, and backgrounds of substantial abuse and violence as well as familial psychopathology. Class 2 was the group most socioeconomically disadvantaged, with the highest percentage of participants coming from poor backgrounds, spending the longest time homeless and working the fewest months. Identifying subgroups of IDU has the potential to guide the development of more targeted and effective strategies for prevention and treatment of this high-risk population.