Alarms: Transforming a Nuisance into a Reliable Tool

  • G. Murias
  • B. Sales
  • L. Blanch


Up to 77% of admissions to medical intensive care units (ICUs) take place, at least in part, for monitoring purposes, even though only 10% of the patients monitored will subsequently have indications for major interventions [1]. Modern ICU equipment takes advantage of a wide range of technologies to track physiological variables in order to detect changes that could be life-threatening. As response time is a key issue, most of these devices are equipped with a more or less sophisticated set of alarms that alert intensivists, nurses or respiratory therapists about changes that could represent a risk to patients.


False Alarm Expert System Pediatric Intensive Care Unit Pulse Oximeter Pulse Pressure Variation 
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  1. 1.
    Thibault GE, Mulley AG, Barnett GO, et al (1980) Medical intensive care: indications, interventions, and outcomes. N Engl J Med 302:938–942PubMedCrossRefGoogle Scholar
  2. 2.
    Kestin IG, Miller BR, Lockhart CH (1988) Auditory alarms during anesthesia monitoring. Anesthesiology 69:106–109PubMedCrossRefGoogle Scholar
  3. 3.
    Lawless ST (1994) Crying wolf: false alarms in a pediatric intensive care unit. Crit Care Med 22:981–985PubMedCrossRefGoogle Scholar
  4. 4.
    Bentt LR, Santora TA, Leverle BJ, Lobue M, Shabot MM (1990) Accuracy and utility of pulse oximetry in the surgical intensive care unit. Curr Surg 47:267–268PubMedGoogle Scholar
  5. 5.
    Tsien CL, Fackler JC (1997) Poor prognosis for existing monitors in the intensive care unit. Crit Care Med 25:614–619PubMedCrossRefGoogle Scholar
  6. 6.
    Deller A, Schuhle B, Konrad F, Kilian J (1988) Alarms of medical-technical equipment in the surgical intensive care unit. A prospective study. Anasth Intensivther Notfallmed 23:238–243PubMedCrossRefGoogle Scholar
  7. 7.
    Kacmarek RM, Meklauss G (1990) The new generation of mechanical ventilation. Crit Care Clin 6:551–578PubMedGoogle Scholar
  8. 8.
    Joint Commission on Accreditation of Health Care Organizations (2002) Preventing ventilator-related deaths and injuries. Sentinel Event Alert, Issue 25Google Scholar
  9. 9.
    Koski Em, Makivirta A, Sukuvaara T, Kari A (1995) Clinicians’ opinions on alarm limits and urgency of therapeutic responses. Int J Clin Monit Comput 12:85–88PubMedCrossRefGoogle Scholar
  10. 10.
    Balogh D, Kittinger E, Benzer A, Hackl JM (1993) Noise in the ICU. Intensive Care Med 19:343–346PubMedCrossRefGoogle Scholar
  11. 11.
    Wikipedia (2006) Sound pressure At: Accessed Dec 2006Google Scholar
  12. 12.
    Aaron JN, Carlisle CC, Carskadon MA, Meyer TJ, Hill NS, Millman RP (1996) Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit. Sleep 19: 707–710PubMedGoogle Scholar
  13. 13.
    Freedman Ns, Gazendam J, Levan L, Pack AI, Schwab RJ (2001) Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 163:451–457PubMedGoogle Scholar
  14. 14.
    Topf M, Dillon E (1988) Noise-induced stress as a predictor of burnout in critical care nurses. Heart Lung 17:567–574PubMedGoogle Scholar
  15. 15.
    Wagner DP, Wineland TD, Knaus WA (1983) The hidden costs of treating severely ill patients: charges and resource consumption in an intensive care unit. Health Care Financ Rev 5:81–86PubMedGoogle Scholar
  16. 16.
    Noseworthy TW, Konopad E, Shustack A, Johnston R, Grace M (1996) Cost accounting of adult intensive care: methods and human and capital inputs. Crit Care Med 24:1168–1172PubMedCrossRefGoogle Scholar
  17. 17.
    Ross AF, Tinker JH (1994) Anesthesia risk. In: Miller RD (ed) Anesthesia, 4th edn. Churchill-Livingstone, New York, pp 536–547Google Scholar
  18. 18.
    Orkin FW (1993) Patient monitoring during anesthesia as an exercise in technology assessment. In: Saidman LJ, Smith NT (eds) Monitoring in Anesthesia, 3rd edn. Butterworth Heineman, London, pp 439–455Google Scholar
  19. 19.
    Lunn JN, Devlin HB (1987) Lessons from the confidential enquiry into perioperative deaths in three NHS regions. Lancet 2:1384–1386PubMedCrossRefGoogle Scholar
  20. 20.
    Pierce EC Jr (1995) The 34th Rovenstine Lecture. Available at: Accessed Dec 2006
  21. 21.
    Mayfield JB (2006) The impact of intraoperative monitoring on patient safety. Anesthesiol Clin 24:407–417PubMedCrossRefGoogle Scholar
  22. 22.
    Cheney FW (2002) Changing trends in anesthesia:related death and permanent brain damage. Society of Anesthesiologists Newsletter 66:6–8Google Scholar
  23. 23.
    Webb RK, Van Der Walt JH, Runciman WB, et al (1993) The Australian Incident Monitoring Study. Which monitor? An analysis of 2000 incident reports. Anaesth Intensive Care 21: 529–542PubMedGoogle Scholar
  24. 24.
    Haller M, Zollner C, Briegel J, Forst H (1995) Evaluation of a new continuous thermodilution cardiac output monitor in critically ill patients: a prospective criterion standard study. Crit Care Med 23:860–866PubMedCrossRefGoogle Scholar
  25. 25.
    Gehring H, Hornberger C, Matz H, Konecny E, Schmucker P (2002) The effects of motion artifact and low perfusion on the performance of a new generation of pulse oximeters in volunteers undergoing hypoxemia. Respir Care 47:48–60PubMedGoogle Scholar
  26. 26.
    Hay WW Jr, Rodden DJ, Collins SM, Melara DL, Hale KA, Fashaw LM (2002 ) Reliability of conventional and new pulse oximetry in neonatal patients. J Perinatol 22:360–366PubMedCrossRefGoogle Scholar
  27. 27.
    Koski EM, Makivirta A, Sukuvaara T, Kari A (1991–1992) Development of an expert system for haemodynamic monitoring: computerized symbolization of on-line monitoring data. Int J Clin Monit Comput 8:289–293PubMedCrossRefGoogle Scholar
  28. 28.
    Becker K, Thull B, Kasmacher-Leidinger H, et al (1997) Design and validation of an intelligent patient monitoring and alarm system based on a fuzzy logic process model. Artif Intell Med 11:33–53PubMedCrossRefGoogle Scholar
  29. 29.
    Oberli C, Urzua J, Saez C, et al (1999) An expert system for monitor alarm integration. J Clin Monit Comput 15:29–35PubMedCrossRefGoogle Scholar
  30. 30.
    Hudson LD (1985) Monitoring of critically ill patients: conference summary. Respir Care 30:628–636Google Scholar
  31. 31.
    Parshuram CS, Kirpalani H, Mehta S, Granton J, Cook D (2006) In-house, overnight physician staffing: a crosssectional survey of Canadian adult and pediatric intensive care units. Crit Care Med 34:1674–1678PubMedCrossRefGoogle Scholar
  32. 32.
    Groeger JS, Strosberg MA, Halpern NA, et al (1992) Descriptive analysis of critical care units in the United States. Crit Care Med 20:846–863PubMedCrossRefGoogle Scholar
  33. 33.
    Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA (2006) Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med 34:1016–1024PubMedCrossRefGoogle Scholar
  34. 34.
    Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr (2000) Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 284:2762–2770PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • G. Murias
    • 1
  • B. Sales
    • 2
  • L. Blanch
    • 3
  1. 1.Intensive Care UnitClinica Bazterrica and Clinica Santa IsabelBuenos AiresArgentina
  2. 2.University Institute Parc PauliSabadellSpain
  3. 3.Critical Care CenterInstitut Universitari Parc PauliSabadellSpain

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