Summary of evidence for threshold setting of multi-parameter electrocardiograph monitor in intensive care unit / 中华危重病急救医学

OBJECTIVE@#To retrieve the evidence for threshold setting of multi-parameter electrocardiograph (ECG) monitors in intensive care unit (ICU), and summarize the best evidence.@*METHODS@#After literature retrieval, clinical guidelines, expert consensus, evidence summary and systematic review that met the requirements were screened. Guidelines were evaluated by the appraisal of guidelines for research and evaluation II (AGREE II), expert consensus and systematic review were evaluated by the Australian JBI evidence-based health care center authenticity evaluation tool, and evidence summary was evaluated by the CASE checklist. High-quality literature was selected to extract evidence related to the use and setup of multi-parameter ECG monitors in the ICU.@*RESULTS@#A total of 19 literatures were included, including 7 guidelines, 2 expert consensus, 8 systematic reviews, 1 evidence summary, and 1 national industry standard. After evidence extraction, translation, proofreading and summary, a total of 32 pieces of evidence were integrated. The included evidence involved the environmental preparation for the application of the ECG monitor, the electrical requirements of the ECG monitor, ECG monitor use process, ECG monitor alarm setting principles, ECG monitor alarm heart rate or heart rhythm monitoring setting, ECG monitor alarm blood pressure monitoring setting, ECG monitor alarm respiratory and blood oxygen saturation threshold setting, alarm delay warning time setting, adjusting alarm setting method, evaluating alarm setting time, improving the comfort of monitoring patients, reducing nuisance alarm report the occurrence, alarm priority processing, alarm intelligent processing and so on.@*CONCLUSIONS@#This summary of evidence involves many aspects of the setting and application of ECG monitor. According to the latest guidelines and expert consensus, it is updated and revised to guide healthcare workers to monitor patients more scientifically and safely, and aims to ensure patient safety.

Parametrização dos alarmes de frequência respiratória em ventiladores mecânicos de pacientes durante o banho / Parameterization of respiratory rate alarms in mechanical ventilators of patients during the bath / Parametrización de las alarmas de frecuencia respiratoria en ventiladores mecánicos de pacientes durante el baño

RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.

ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.

RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.

Effectiveness of application of a manual for improvement of alarms management by nurses in Intensive Care Units / Efectividad de la aplicación de un manual para la gestión de alarmas en enfermeros de Unidades de Cuidados Intensivos / Eficácia da aplicação de manual para gerenciamento de alarmes em enfermeiros de Unidades de Terapia Intensiva

Objective. To evaluate the effects of application of a manual on the improvement of alarms management in Intensive Care Units (ICU). Methods. This quasi-experimental study evaluated the effectiveness of the introduction into of a manual for alarm management and control in the ICU of a hospital in southeastern Iran. The intervention was a 4-hour workshop was on topics related to the adverse effects of alarms, standardization of ECG, oxygen saturation and blood pressure monitoring systems, and the use of ventilators and infusion pumps. Data were collected thorough 200 hours of observation of 60 ICU nurses (100 hours' pre-intervention and 100 hours' post-intervention). Response time, type of response, customization of alarm settings for each patient, the person responding to an alarm, and the cause of the alarm were analyzed. Alarms were classified into three types: false, true and technical. Results. The results showed a statistically significant difference between the pre- and post-intervention frequency of alarm types, frequency of monitoring parameters, customized monitoring settings for patients, and individuals who responded to alarms. The percentage of effective interventions was significantly higher for all parameters after the intervention (46.9%) than before the intervention (38.9%). Conclusion. The employment of a manual for management of alarms from electronic equipment in ICUs can increase the frequency of appropriate responses to alarms in these units.

Objetivo. Evaluar los efectos de la aplicación de un manual en el mejoramiento de la gestión de las alarmas en enfermeros las Unidades de Cuidados Intensivos -UCI-. Métodos. Estudio cuasi- experimental en el que se evaluó la efectividad de la introducción de un manual en la práctica para la prevención y el control de alarmas en una UCI de un hospital del sudeste de Irán. Se realizó un taller de 4 horas de duración que incluía temas relacionados con los efectos adversos de las alarmas, la estandarización en los sistemas de monitoreo de ECG, saturación de oxígeno y presión arterial, y del uso de ventiladores y de bombas de infusión. Se realizaron 200 horas de observación a 60 enfermeras de la UCI (100 horas antes y 100 horas después de la intervención). Se analizó el tiempo de respuesta, el tipo de respuesta, la personalización de los ajustes de la alarma para cada paciente, la persona que responde a una alarma y la causa de la alarma. Las alarmas se clasificaron en tres tipos: falsas, verdaderas y técnicas. Resultados. Los hallazgos mostraron diferencias estadísticamente significativas entre la frecuencia de los tipos de alarma antes y después de la intervención, la frecuencia de los parámetros de monitorización, los ajustes de monitorización personalizados para los pacientes y las personas que responden a las alarmas. El porcentaje de intervenciones efectivas para el total de parámetros fue significativamente mayor después de la intervención (46.9%) que antes de la misma (38.9%). Conclusión. Los resultados del estudio muestran que el empleo del manual para la gestión de las alarmas de los equipos electrónicos en una UCI puede aumentar la frecuencia de respuestas adecuadas de los enfermeros de estos servicios.

Objetivo. Avaliar os efeitos da aplicação de um manual na melhoria do gerenciamento de alarmes em enfermeiros de Unidades de Terapia Intensiva -UTI-. Métodos. Estudo quase-experimental no qual foi avaliada a eficácia da introdução na prática de um manual para prevenção e controle de alarmes em uma UTI de hospital no sudeste do Irã. Foi realizado um workshop de 4 horas que incluiu tópicos relacionados aos efeitos adversos dos alarmes, padronização dos sistemas de monitoração de ECG, saturação de oxigênio e pressão arterial e uso de ventiladores e bombas de infusão. Foram realizadas 200 horas de observação em 60 enfermeiras de UTI (100 horas antes e 100 horas após a intervenção). O tempo de resposta, o tipo de resposta, a personalização das configurações de alarme para cada paciente, a pessoa que responde a um alarme e a causa do alarme foram analisados. Os alarmes foram classificados em três tipos: falso, verdadeiro e técnico. Resultados. Os resultados mostraram diferenças estatisticamente significativas entre a frequência dos tipos de alarme antes e depois da intervenção, a frequência dos parâmetros de monitoração, configurações de monitoração personalizadas para pacientes e pessoas que respondem aos alarmes. O percentual de intervenções eficazes para todos os parâmetros foi significativamente maior após a intervenção (46,9%) do que antes (38,9%). Conclusão. Os resultados do estudo mostram que a utilização do manual para gerenciamento de alarmes de equipamentos eletrônicos em UTIs pode aumentar a frequência de respostas adequadas aos alarmes nos enfermeiros desses serviços.

Clinicopathological Studies on Rats Exposed to Municipal Landfill Gaseous and Particulate Emissions

The study assessed the Clinicopathological changes of Wistar rats exposed to municipal landfill gaseous particulate emissions. Four groups of Wistar rats were exposed to the different sites of landfill emission with use of filters for filtering landfill gaseous emission while the control group was not exposed. Performance of the animals was evaluated weekly, blood and lung, liver, kidney and heart tissues were taken for haematological and histopatholgical examinations. At the end of six weeks exposure, the peak weight was recorded as 108.96±0.45 of Group B as compared to 126.352±0.88 of the Control Group, as well as the decrease in the body weight of Group A-D compared to the Control Group. There was leucocytosis, lymphocytosis and neutrophilia in the rats that were exposed to landfill emission. There were pulmonary, hepatic, and renal lesions while the heart was spared. Changes were observed on the use of filters for filtering landfill gaseous emission. The 3M 6001 CN Gas Mask Carnister Cartridge which filters 50% of landfill emission together with black polythene nylon restricting external air into the filtered cage was not sufficient to reduce the effect of landfill gaseous emission at the end of the exposure period. The screening with PM2.5 material which filters 100% of PM2.5 emission was only able to screen PM2.5 emission but could not screen other landfill gaseous emission. This indicates that landfill gaseous emission is capable of inducing respiratory problems and tissue damage on dumpsite workers if there is sufficient and continuous exposure to landfill gaseous emissions. To prevent the hazard that may arose from dumpsite activities; gas nose mask respirator is recommended for an individual who works as scavengers and landfill workers before entering the dumpsite environment..

A Survey of Patient Monitoring Alarms in Cardiac Care Units / 中国医疗器械杂志

OBJECTIVE@#The patient monitors were used to explore the alarm fatigue in a cardiac care unit and to investigate the awareness and reaction of nurse to alarms.@*METHODS@#A semi-structured survey was taken to acquire nurses' feeling and knowledge about monitoring alarm. Three full-time researchers were scheduled to track the alarms with annotations, and analyze the alarm data of 12 patient monitors using central monitoring system.@*RESULTS@#A total of 72 310 unique alarms occurred in the 67-day study period. About 75.7% of them were physiological alarms and less than 10% of medium-low alarms were false positives. The average alarm rate was 128 alarms/patient-day.@*CONCLUSIONS@#There remains alarm fatigue in CCU, the alarm accuracy has improved than the past by applying new technologies. In some cases, clinicians will pay more attention to trend alarm and combination alarm.

Research on Patient Monitoring Alarms in ICU and NICU / 中国医疗器械杂志

OBJECTIVE@#The patient monitors were used to explore the alarm actuality in a ICU and NICU to investigate the awareness and reaction of medical staff to alarms.@*METHODS@#A series of surveys and interviews were taken to acquire clinicians' feelings and attitudes to monitoring alarms. The researchers were scheduled to track the alarms with annotations, and collect the alarm data of patient monitors using central monitoring system.@*RESULTS@#A total of 235 387 and 67 783 alarms occurred in ICU and NICU respectively. The average alarm rate was about 142 alarms/patient-day in ICU and 96 alarms/patient-day in NICU.@*CONCLUSIONS@#There remains alarm fatigue in ICU and NICU, the main reason is the large number of false alarms and clinically irrelevant alarms. In addition, patient monitor is still in the level of threshold alarms or combined alarms, the data integrity and intelligence level need to be improved in future.

Kidney disease and hemodialysis: identification of blood biomarkers to detect heart failure and kidney failure / Enfermedad renal y hemodiálisis: identificación de biomarcadores sanguíneos para detectar insuficiencia cardíaca e insuficiencia renal

Abstract Objectives: to identify valid blood biomarkers to detect heart failure and kidney failure associated with kidney disease and hemodialysis Methods: systematic literature review conducted in August 2018 in the following: Web Of Science, PubMed, Scopus, Cinahal, Cochrane, Science Direct and Lilacs. The guiding question was: "What are the blood biomarkers used to detect heart failure and kidney failure?" A total of537 publications were found, 94 of these appeared more than once, 383 were excluded after reading titles and abstracts, 32 were excluded after reading the full texts, and 10 were excluded in the quantitative and qualitative synthesis. Results: 18 papers compose the final sample and report laboratory and imaging tests, instruments to assess the risk of kidney and heart failure, and also clinical management of the progression of kidney and heart failure. All the studies correlated risk of mortality and death outcome. Conclusion: laboratory tests are important to identifying kidney and heart failure and need to be used to improve clinical management of the hemodialysis treatment of people with chronic kidney disease in order to improve quality of life and life expectancy.

The influence of nursing activities score on clinical alarms service / La influencia de la nursing activities score en el servicio de alarmas clínicas / A influência do nursing activities score no atendimento aos alarmes clínicos

ABSTRACT Objectives: to estimate the magnitude of the Nursing Activities Score effect on multiparametric monitor alarm response and staff response time. Methods: an observational, cross-sectional study outlined as an open cohort, performed in an Adult General Intensive Care Unit. The time taken for alarms triggered by the multi-parameter monitors was timed and characterized as attended or not. Results: the study obtained a total of 254 alarms triggered from the multiparameter monitors of 63 patients. The mean number of alarms triggered was 4.5 alarms per period/observation and 1.5 alarms/hour. The study showed that the Nursing Activities Score is associated with an additional probability of 4% (p < 0.05) of an alarm being met, for each additional point in the scale, and reduction in team response time. Conclusion: it has been verified that Nursing Activities Score has a direct relationship with the attendance and with the response time to the alarms triggered.

RESUMEN Objetivos: estimar la magnitud del efecto del Nursing Activities Score en la atención a las alarmas de los monitores multiparamétricos y en el tiempo de respuesta del equipo. Métodos: estudio observacional, seccional delineado como una cohorte abierta, realizado en una Unidad de Terapia Intensiva General de Adultos. El tiempo hasta la atención de las alarmas disparadas de los monitores multiparamétricos fue cronometrado y caracterizados como atendidos o no. Resultados: el estudio obtuvo un total de 254 alarmas disparadas de los monitores multiparamétricos de 63 pacientes. El promedio de alarmas disparadas fue de 4,5 alarmas por período/observación y 1,5 alarmas/hora. El estudio demostró que el Nursing Activities Score está asociado a una probabilidad adicional de 4% (p < 0,05) de una alarma ser atendida, para cada punto adicional en la escala, y reducción en el tiempo de respuesta del equipo. Conclusiones: se verificó que Nursing Activities Score tiene relación directa con la atención y con el tiempo de respuesta a las alarmas disparadas.

RESUMO Objetivos: estimar a magnitude do efeito do Nursing Activities Score no atendimento aos alarmes dos monitores multiparamétricos e no tempo de resposta da equipe. Métodos: estudo observacional, seccional delineado como coorte aberta, realizado em uma Unidade de Terapia Intensiva geral de adultos. O tempo até o atendimento dos alarmes disparados dos monitores multiparamétricos foi cronometrado e caracterizado como atendido ou não. Resultados: o estudo obteve um total de 254 alarmes disparados dos monitores multiparamétricos de 63 pacientes. A média de alarmes disparados foi de 4,5 alarmes por período/observação e 1,5 alarmes/hora. O estudo demonstrou que o Nursing Activities Score está associado a uma probabilidade adicional de 4% (p < 0,05) de um alarme ser atendido, para cada ponto adicional na escala, e redução no tempo de resposta da equipe. Conclusões: verificou-se que Nursing Activities Score possui relação direta com o atendimento e com o tempo de resposta aos alarmes disparados.

Research of Methods to Reduce Alarm Fatigue of Monitoring System / 中国医疗器械杂志

OBJECTIVE@#In order to solve alarm fatigue, the algorithm optimization strategies were researched to reduce false and worthless alarms.@*METHODS@#A four-lead arrhythmia analysis algorithm, a multiparameter fusion analysis algorithm, an intelligent threshold reminder, a refractory period delay technique were proposed and tested with collected 28 679 alarms in multi-center study.@*RESULTS@#The sampling survey indicate that the 80.8% of arrhythmia false alarms were reduced by the four-lead analysis, the 55.9% of arrhythmia and pulse false alarms were reduced by the multi-parameter fusion analysis, the 28.0% and 29.8% of clinical worthless alarms were reduced by the intelligent threshold and refractory period delay techniques respectively. Finally, the total quantity of alarms decreased to 12 724.@*CONCLUSIONS@#To increase the dimensionality of parametric analysis and control the alarm limits and delay time are conducive to reduce alarm fatigue in intensive care units.

The use of the Modified Early Obstetric Warning System (MEOWS) in women after pregnancies: a descriptive study / Aplicação do Modified Early Obstetric Warning System (MEOWS) em mulheres após gestações: um estudo descritivo

Abstract Objectives: to evaluate the modified early obstetric warning system (MEOWS) in women after pregnancies in a tertiary hospital in Brazil. Methods: a descriptive study was conducted with 705 hospitalized women. Vital signs (systolic and diastolic blood pressure, heart rate, respiratory rate, temperature) and lochia were registered on medical records and transcribed into the MEOWS chart of physiological parameters. On this graphic chart, yellow alerts were used to present moderate abnormalities in vital signs, while severe abnormalities were presented in red. The presence of at least one red alert or two yellow alerts were triggered to indicate the need for medical evaluation. Results: although abnormalities were found in the physiological parameters of 49.8% of the women identified from MEOWS triggers, medical evaluation was only requested for three patients (0.8%). Conclusions: in a retrospective application of the use of MEOWS showed a significant number of patients had triggered in which the nursing team did not recognize 99.2% of cases. This finding could be attributed to the fact that MEOWS has not been yet adopted in this service as part of the nursing care. The application of this tool would result in a better care because critical situations would be recognized and corrected quickly, avoiding unfavorable outcomes.

Resumo Objetivos: avaliar o modified early obstetric warning system (MEOWS) em mulheres após gestações, em um hospital terciário do Brasil. Métodos: foi realizado um estudo descritivo incluindo 705 mulheres internadas. Os sinais vitais (pressão arterial sistólica e diastólica, frequência cardíaca, frequência respiratória, temperatura) e lóquios, registrados no prontuário, foram transcritos para o gráfico de parâmetros fisiológicos do MEOWS. Neste gráfico, anormalidades moderadas nos sinais vitais eram sinalizadas por alertas amarelos, enquanto anormalidades graves eram sina-lizadas em vermelho. A presença de, pelo menos, um alerta vermelho ou dois alertas amarelos foi chamada de eventos gatilho, indicando necessidade de avaliação médica. Resultados: dentre as mulheres estudadas, 49,8% apresentaram anormalidades nos parâmetros fisiológicos, através da identificação de eventos gatilho no MEOWS, porém avaliação médica foi solicitada para apenas três pacientes, resultando num percentual de 0,8%. Conclusões: a utilização do MEOWS, de forma retrospectiva, evidenciou uma quantidade significativa de pacientes apresentando eventos gatilho, os quais não foram reconhecidos pela equipe de enfermagem em 99,2% dos casos. Este achado pode ser atribuído ao fato de o MEOWS ainda não ser adotado no serviço como parte da rotina dos cuidados de enfermagem. A aplicação dessa ferramenta resultaria numa assistência melhor, pois situações críticas seriam reconhecidas e corrigidas com maior precocidade, evitando desfechos desfavoráveis.

Individualized parameterization of multiparametric monitors alarms in infarcted patients / Parametrización individualizada de alarmas de monitores multiparamétricos en pacientes infartados / Parametrização individualizada de alarmes de monitores multiparamétricos em pacientes infartados

ABSTRACT Objective: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. Method: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. Results: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). Conclusion: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.

RESUMEN Objetivo: Medir la magnitud del efecto de un protocolo de parametrización individualizada de alarmas hemodinámicas en pacientes con infarto agudo de miocardio. Método: Ensayo clínico pragmático, open label y single arm cuya intervención ocurrió por medio de un protocolo validado y testado en 32 pacientes, utilizándose monitores multiparamétricos. Las alarmas de frecuencia cardíaca, presión arterial, frecuencia respiratoria, saturación de oxígeno y segmento ST fueron valorados y clasificados según su consistencia clínica, una hora antes y después de la intervención, durante 64 horas. Resultados: El protocolo obtuvo un índice de Validez de Contenido de 0,92. De las 460 alarmas registradas, 261 fueron consideradas inconsistentes antes de la intervención y 47 después. El Riesgo Relativo de las alarmas incoherentes después del protocolo fue de 0,32 (IC 95% 0.23-0.43, p <0,0001). Conclusión: El protocolo se mostró un factor protector al surgimiento de alarmas clínicas inconsistentes de monitores multiparamétricos.

RESUMO Objetivo: Medir a magnitude do efeito de um protocolo de parametrização individualizada de alarmes hemodinâmicos em pacientes com infarto agudo do miocárdio. Método: Ensaio clínico pragmático, open label e single arm, cuja intervenção ocorreu por meio de um protocolo validado e testado em 32 pacientes usando monitores multiparamétricos. Os alarmes de frequência cardíaca, pressão arterial, frequência respiratória, saturação de oxigênio e segmento ST foram mensurados e classificados quanto à consistência clínica uma hora antes e após a intervenção, durante 64 horas. Resultados: O protocolo obteve Índice de Validade de Conteúdo de 0,92. Dos 460 alarmes registrados, 261 foram considerados inconsistentes antes da intervenção e 47 após. O Risco Relativo de alarmes inconsistentes após o protocolo foi de 0,32 (IC 95% 0.23-0.43, p<0,0001). Conclusão: O protocolo mostrou-se um fator protetor ao surgimento de alarmes clínicos inconsistentes de monitores multiparamétricos.

Utilidad de la identificación de los signos de alarma en niños y adolescentes con dengue / Usefulness of warning signs´ identification in children and adolescents with dengue

Introducción: El dengue es una enfermedad capaz de producir extravasación importante de plasma con hipovolemia y choque, signos frecuentes de gravedad y causa de muerte. Objetivo: Valorar la utilidad de la identificación de los signos de alarma en niños y adolescentes con dengue. Métodos: Estudio prospectivo de 110 pacientes (0-18 años de edad y de ambos sexos) quienes presentaron signos de alarma de dengue grave y se trataron con soluciones cristaloides por vía intravenosa durante su ingreso hospitalario y un número igual de pacientes que no tuvieron esos signos y no requirieron dicho tratamiento. Se aplicó retrospectivamente la clasificación de la OMS 2009 y se comparó con la precedente de1977. Resultados: Los signos de alarma encontrados con mayor frecuencia fueron: dolor abdominal intenso y mantenido (50 por ciento) y vómitos repetidos 3 o más en 4 horas (34,3 por ciento, que aparecieron durante el dia de la defervescencia en 46 por ciento de los pacientes y la mitad mostró ascitis. Después de seis horas de tratamiento con soluciones cristaloides por vía intravenosa, el porcentaje de pacientes con dolor abdominal disminuyó a 30 por ciento, y el de pacientes con signos de bajo gasto cardiaco (hipotensión) disminuyó de 30 a 10 por ciento. No hubo fallecidos. Conclusiones: Los signos alarma del dengue grave cuya identificación ha sido recomendada por OMS y OPS y tambien en las Guías Cubanas, tienen especial importancia en la atención de niños y adolescentes hospitalizados y demostrada su utilidad tanto en la prevencion del agravamiento como en la mejoria del cuadro grave cuando fue tratado en sus inicios(AU)

Introduction: Dengue is a disease that is capable of producing an important plasma extravasation with hypovolaemia and shock, which are frequent signs of seriousness and causes of death. Objective: To value the usefulness of warning signs identification in children and adolescents with dengue. Methods: A prospective study was carried out to 110 children (0-18 years old, both sexes) at Dr. Angel A. Aballi University Pediatric Hospital who had confirmed dengue´s warning signs and were admitted to the Intensive Care Unit and treated with crystalloids solutions by intravenous route. An equivalent number of confirmed dengue patients who did not have warning signs nor received that treatment were the control group. Clinical data and the results of laboratory tests were recorded since patients were admitted in the Intensive Care (ICU) and after 6 hours of treatment. The 2009 World Health Organization (WHO) Dengue Classification was used to classify patients retrospectively and a comparison was made with the WHO 1977 Dengue Classification. Results: Clinical warning signs that were more frequently identified were: intensive and continuous abdominal pain (50 percent) and frequent vomiting (3 or more in 4 hours) (34.3 percent) that appeared during defervescence (46 percent of patients), and half of them presented ascites. After 6 hours of treatment with the crystalloids solutions, the number of patients with abdominal pain decreased to 30 percent and those with low cardiac output (hypotension) from 35 percent to 10 percent. No fatalities occurred. Conclusions: Warning signs of severe dengue, which identification has been recommended by WHO and PAHO and also in the Cuban Guidelines, has special importance in the care of hospitalized children and adolescents; and it was demonstrated its usefulness in the prevention of severity as in the improvement of the signs of severity when those were treated in the onset period(AU)

Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis / Estudo do perfil dos problemas de comportamento e dos índices de qualidade de vida numa coorte pediátrica de enurese monossintomática

Abstract Objective: To evaluate and correlate, before and after the therapeutic intervention, the behavioral problem scores evaluated by the CBCL/6-18 questionnaire and the quality of life indexes evaluated by the PedsQL™ 4.0 in patients with monosymptomatic nocturnal enuresis. Method: After the initial evaluation and completion of the CBCL/6-18 questionnaire, a multidisciplinary evaluation and completion of the PedsQL™ 4.0 questionnaire was performed. Of the initially evaluated 140 children and adolescents aged 6-16 years, 58 were excluded due to non-monosymptomatic enuresis or associated comorbidities. Of the initially included 82 patients, who were randomized to three treatment groups, 59 completed the CBCL/6-18 and PedsQL™ 4.0 questionnaires at the end of the treatment and were included in this study. The α error was set at 5% for ruling out the null hypothesis. Results: Of the total of 59 participants, 45.8% responded with total success, 23.7% were partially successful, 23.7% did not reach the improvement criteria, and 6.8% gave up the treatment. There was a significant increase in quality of life indexes and a reduction of post-intervention behavioral problem scores, in the three proposed modalities, in patients who had a total or partial response to treatment. There was no correlation between higher scores of pre-treatment behavior problems and therapeutic failure. Conclusions: Only the participants who successfully responded to interventions showed improvement in quality of life and behavioral problems, which indicates that enuresis is a primary problem that has a negative impact on these parameters. The authors suggest that it is possible to achieve success in the treatment of monosymptomatic enuresis, even in patients with high pre-intervention behavioral problem scores.

Resumo Objetivo: Avaliar e relacionar, pré e pós-intervenção terapêutica, em pacientes com enurese noturna monossintomática, os escores de problemas de comportamento, avaliados pelo questionário CBCL/6-18, e os índices de qualidade de vida, avaliados pelo PedsQL™ 4.0. Método: Após avaliação inicial e preenchimento CBCL6/18, procedeu-se avaliação multidisciplinar e preenchimento do PedsQL™ 4.0. Das 140 crianças e adolescentes de 6 a 16 anos inicialmente avaliados, 58 foram excluídos por enurese não monossintomática ou comorbidades associadas. Dos 82 pacientes inicialmente incluídos e randomizados em três grupos de tratamento, 59 preencheram o CBCL/6-18 e PedsQL™ 4.0 no fim do tratamento e puderam ser incluídos neste trabalho. O erro alfa foi estabelecido em 5% para descarte da hipótese de nulidade. Resultados: Dos 59 participantes 45,8% responderam com sucesso total, 23,7% tiveram sucesso parcial, 23,7% não atingiram critério de melhoria e 6,8% desistiram do tratamento. Verificou-se aumento significativo dos índices de qualidade de vida e redução dos escores de problemas de comportamento pós-intervenção, nas três modalidades propostas, nos pacientes que obtiveram resposta total ou parcial ao tratamento. Não se demonstrou correlação entre maiores escores de problemas de comportamento pré-tratamento e insucesso terapêutico. Conclusões: Apenas os participantes que responderam com sucesso às intervenções melhoraram em sua qualidade de vida e problemas comportamentais, o que indica que a enurese é um problema primário que impacta negativamente esses parâmetros. Sugere-se que é viável obter sucesso no tratamento da enurese monossintomática, mesmo em pacientes com altos escores de problemas de comportamento pré-intervenção.

Alarm fatigue and the implications for patient safety / Fatiga de alarmas y las implicaciones para la seguridad del paciente / Fadiga de alarmes e as implicações para segurança do paciente

ABSTRACT Objective: To measure the response time of health professionals before sound alarm activation and the implications for patient safety. Method: This is a quantitative and observational research conducted in an Adult Intensive Care Unit of a teaching hospital. Three researchers conducted non-participant observations for seven hours. Data collection occurred simultaneously in 20 beds during the morning shift. When listening the alarm activation, the researchers turned on the stopwatches and recorded the motive, the response time and the professional conduct. During collection, the unit had 90% of beds occupied and teams were complete. Result: We verified that from the 103 equipment activated, 66.03% of alarms fatigued. Nursing was the professional category that most provided care (31.06%) and the multi-parameter monitor was the device that alarmed the most (66.09%). Conclusion: Results corroborate the absence or delay of the response of teams, suggesting that relevant alarms might have been underestimated, compromising patient safety.

RESUMEN Objetivo: Mensurar el tiempo-respuesta de los profesionales de salud delante del disparo de las alarmas sonoras, y las implicaciones para la seguridad del paciente. Método: Investigación cuantitativa, observacional, en una Unidad de Terapia Intensiva - Adulto de un hospital de enseñanza. Los tres investigadores han realizado observaciones no participativas durante 7 horas. La recogida de los datos ha ocurrido simultáneamente en 20 camillas en el período diurno. Al oír el disparo, los investigadores accionaban los cronómetros y registraban el motivo, el tiempo-respuesta y la conducta profesional. Durante la recogida, la unidad estaba con el 90% de las camillas ocupadas y los equipos estaban completados. Resultados: Certificamos que, de los 103 equipamientos que han sido disparados, el 66,03% de las alarmas han fatigado. La enfermería ha sido la categoría profesional que más ha atendido (el 31,06%), y el monitor multiparámetros ha alarmado (el 66,09%). Conclusión: Los resultados han corroborado la ausencia o el retardo de la respuesta del equipo, sugiriendo que las alarmas relevantes hayan sido menospreciadas, comprometiendo la seguridad de los pacientes.

RESUMO Objetivo: Mensurar o tempo-resposta dos profissionais de saúde diante ao disparo dos alarmes sonoros e as implicações para a segurança do paciente. Método: Pesquisa quantitativa, observacional, em uma Unidade de Terapia Intensiva Adulto de um Hospital de Ensino. Os três pesquisadores realizaram observações não participativas durante 7 horas. A coleta de dados ocorreu simultaneamente em 20 leitos no período diurno. Ao ouvir o disparo, os pesquisadores acionavam os cronômetros e registravam o motivo, o tempo-resposta e a conduta profissional. Durante a coleta a unidade estava com 90% dos leitos ocupados e as equipes estavam completas. Resultados: Verificamos que, dos 103 equipamentos disparados, 66,03% dos alarmes fatigaram. A enfermagem foi a categoria profissional que mais atendeu (31.06%), e o monitor multiparâmetros alarmou (66,09%). Conclusão: Os resultados corroboram a ausência ou retardo de resposta da equipe, sugerindo que alarmes relevantes tenham sido menosprezados, comprometendo a segurança dos pacientes.

Signos de alarma en pacientes cubanos con dengue según nueva clasificación revisada de la Organización Mundial de la Salud / Warning signs in Cuban patients with dengue fever according to new reviewed classification of the World Health Organization

Se realizó un estudio observacional, descriptivo y transversal en el Instituto de Medicina Tropical Pedro Kourí de La Habana, donde estuvieron ingresados 485 pacientes desde enero hasta diciembre de 2012 con diagnóstico de infección por dengue, de los cuales se escogió una muestra de 247. Entre los signos de alarma más comunes sobresalieron la cifra ascendente del hematocrito (54,6 por ciento y el dolor abdominal intenso o mantenido o de ambos tipos (46,1 por ciento . Las señales de alarma aparecieron por lo general al ceder la fiebre; del total de pacientes que las presentaron en algún momento de su evolución, 81,2 por ciento fueron tratados con hidratación intravenosa precoz y ninguno evolucionó hacia la forma grave de la enfermedad. La terapia hidratante parenteral se inició tardíamente en 18,8 por ciento de los afectados, incluidos todos aquellos en estado grave.

An observational, descriptive and cross sectional study was carried out in Pedro Kourí Tropical Medicine Institute from Havana, where 485 patients were admitted from January to December, 2012 with diagnosis of infection due to dengue fever, from whom a sample of 247 was chosen. Among the most common warning signs there were the increasing values of hematocrit (54.6 percent), and the intense or sustained abdominal pain or both types (46.1 percent). The warning signs generally appeared when fever ceased, and of the total of patients that presented it, 81.2 percent at some moment of their clinical course were treated with early intravenous hydration, and none developed the serious form of the disease. The parenteral hydration therapy began belatedly in 18.8 percent of the affected, including all those in severe state.

Condutas dos profissionais de enfermagem frente aos alarmes dos ventiladores mecânicos em uma unidade de terapia intensiva / Conductas de los profesionales de enfermería frente a las alarmas de los ventiladores mecánicos en una unidad de terapia intensiva / Conduct of nursing professionals to the alarms of mechanical ventilators in an intensive care unit

OBJETIVOS: caracterizar quais alarmes sonoros disparados por ventiladores mecânicos foram mais frequentes, descrever o tempo estímulo-resposta aos alarmes do ventilador mecânico e analisar as condutas dos profissionais de enfermagem diante dos alarmes ventilatórios. MÉTODO: pesquisa descritiva, quantitativa, realizada em uma unidade de terapia intensiva de um hospital universitário do Rio de Janeiro. Os dados foram tratados com estatística descritiva. RESULTADOS: realizadas 60 horas de observação, nesse período, soaram 25 alarmes de ventiladores mecânicos, 20 alarmes foram atendidos e 5 pararam sem nenhuma intervenção. Os alarmes mais prevalentes foram volume minuto expirado baixo, e pressão de vias aéreas alta. O tempo mínimo para atendimento dos alarmes foi 10 segundos, o tempo máximo 3 minutos, e o tempo médio 38 segundos. As condutas mais realizadas pelos profissionais de enfermagem foram aspiração traqueal, reposicionamento do circuito e ausculta pulmonar. CONCLUSÃO: os achados da pesquisa apontaram que, nos alarmes mais prevalentes, as condutas dos profissionais de enfermagem, de acordo com a literatura, não foram suficientes para a resolutividade dos problemas apresentados.

OBJECTIVES: to characterize which alarms were activated by mechanical ventilators were more frequent, to describe the stimulusresponse time to the mechanical ventilator alarms and to analyze the nursing professionals conducts before ventilatory alarms. METHOD: descriptive, quantitative research performed in an intensive care unit of a university hospital in Rio de Janeiro. The data were treated with descriptive statistics. RESULTS: 60 hours of observation were performed. During this period, 25 mechanical ventilator alarms sounded, 20 alarms were answered and 5 stopped without any intervention. The most prevalent alarms were low expired minute volume, and high airway pressure. The minimum time to answer the alarms was 10 seconds, the maximum time 3 minutes, and the average time 38 seconds. The most accomplished conducts by the nursing professionals were tracheal aspiration, circuit repositioning and pulmonary auscultation. CONCLUSION: the research findings pointed out that, in the most prevalent alarms, nursing professionals' conduct, according to the literature, was not enough to solve the problems presented.

OBJETIVOS: caracterizar que alarmas sonoras disparadas por ventiladores mecánicos fueron más frecuentes, describir el tiempo estímulo-respuesta a las alarmas del ventilador mecánico y analizar las conductas de los profesionales de enfermería ante las alarmas ventilatorios. MÉTODO: investigación descriptiva, cuantitativa realizada en una unidad de terapia intensiva de un hospital universitario de Río de Janeiro. Los datos fueron tratados con estadística descriptiva. RESULTADOS: realizadas 60 horas de observación, en ese período sonaron 25 alarmas de ventiladores mecánicos, 20 alarmas fueron atendidas y 5 pararon sin ninguna intervención. Las alarmas más prevalentes fueron el volumen minuto expirado bajo, y la presión de las vías aéreas alta. El tiempo mínimo para la atención de las alarmas fue 10 segundos, el tiempo máximo 3 minutos, y el tiempo promedio 38 segundos. Las conductas más realizadas por los profesionales de enfermería fueron aspiración traqueal, reposicionamiento del circuito y auscultación pulmonar. CONCLUSIÓN: los hallazgos de la investigación apuntaron que, en las alarmas más prevalentes, las conductas de los profesionales de enfermería, de acuerdo con la literatura, no fueron suficientes para la resolución de los problemas presentados.

Evaluation of Clinical Alarms and Alarm Management in Intensive Care Units

PURPOSE: This study aimed to investigate the clinical alarm occurrence and management of nurses toward clinical alarms in the intensive care unit (ICU). METHODS: This observational study was conducted with 40 patients and nurses cases in two ICUs of a university hospital. This study divided 24 hours into the unit of an hour and conducted two times of direct observation per unit hour for 48 hours targeting the medical devices applied to 40 patients. Data were analyzed using IBM SPSS Statistics 23. RESULTS: On average, 3.8 units of medical devices were applied for each patient and the ranges of alarm settings were wide. During 48 hours, 184 cases of clinical alarm were occurred by four types of medical devices including physiological monitors, mechanical ventilators, infusion pumps, and continuous renal replacement therapy. Among them, false alarm was 110 cases (59.8%). As for the alarm management by ICU nurses, two-minute alarm mute took up most at 38.0% (70 cases), and no response was second most at 32.6% (60 cases). When valid alarm sounded, nurses showed no response at 43.2%. CONCLUSION: The findings suggest that a standard protocol for alarm management should be developed for Korean ICU settings. Based on the protocol, continuous training and education should be provided to nurses for appropriate alarm management.

Research on the Clinical Alarm Management Mechanism Based on Closed-loop Control Theory / 中国医疗器械杂志

This paper proposes a clinical alarm management system based on the theory of the closed loop control. The alarm management mechanism can be divided into the expected standard, improving execution rule, rule execution, medical devices with alarm functions, results analysis strategy and the output link. And, we make relevant application and discussion. Results showed that the mechanism can be operable and effective.

Design of Real-time Disease Warning System Based on Storm Technology / 中国医疗器械杂志

With the improvement of the quality of clinical diagnosis and treatment, the traditional scheduled "ward round" mode cannot meet the demands for real-time monitoring of acute and critically ill patients. This paper introduces the Storm, a real-time data stream processing technology and its application in the real time disease early warning system. By collecting the clinical data flow and calculating the MEWS scores in real time, the system can identify the potential deterioration of the disease, and promptly notify the medical staff. Score calculation results can be stored for further analysis and presentation as well.

Stimulus-response time to alarms of the intra-aortic balloon pump: safe care practices / El tempo estíulo-respuesta de las alarmas del balón de contrapulsación intraaórtico: prácticas para el cuidado seguro / Tempo estímulo-resposta aos alarmes do balão intraórtico: práticas para cuidado seguro

ABSTRACT Objective: To characterize the sound alarms of the Intra-Aortic Balloon Pump (IABP) during aortic counterpulsation therapy; to measure the stimulus-response time of the team to these; and to discuss the implications of increasing this time for patient safety from the alarm fatigue perspective. Method: This is an observational and descriptive study with quantitative and qualitative approach, case study type, carried out in a Cardiac Surgical Intensive Care Unit. Results: The most audible IABP alarm was the one of high priority increased-reduced diastolic blood pressure. The stimulus-response time was 33.9 seconds on average. Conclusion: Managing the alarms of these equipment is essential to minimize the occurrence of the alarm fatigue phenomenon and to offer a safer assistance to patients who rely on this technology.

RESUMEN Objetivo: Caracterizar las alarmas sonoras disparadas por el balón de contrapulsación intraaórtico (BCIA) durante la terapia de contrapulsaciónaórtica; calcular el tiempo estímulo-respuesta del dispositivo y discutir las implicaciones al extenderse el tiempo para la seguridad del paciente cuando presente fatiga por las alarmas. Método: Estudio descriptivo observacional, con enfoques cuantitativo y cualitativo, de tipo estudio de caso, llevado a cabo en una Unidad de Cuidado Cardiontensivo Quirúrgico. Resultados: La alarma sonora más disparada por el BCIA fue la de la diástole aumentada y disminuida, de alta necesidad. El promedio del tiempo estímulo-respuesta fue de 33,9 segundos. Conclusión: La gestión de las alarmas de este dispositivo se hace imprescindible para minimizar su fatiga a los pacientes que lo utilizan y para ofrecerles un cuidado más seguro.

RESUMO Objetivo: Caracterizar os alarmes sonoros disparados pelo balão intra-aórtico (BIA) durante a terapia de contrapulsação aórtica; medir o tempo estímulo-resposta da equipe a esses e discutir as implicações do alargamento desse tempo para a segurança do paciente na perspectiva da fadiga de alarmes. Método: Trata-se de um estudo descritivo observacional, com abordagem quanti-qualitativa, do tipo estudo de caso, realizado em uma Unidade de Terapia Cardiointensiva Cirúrgica. Resultados: O alarme sonoro mais disparado pelo BIA foi o de pressão diastólica aumentada-diminuída, de alta prioridade. O tempo estímulo-resposta foi em média de 33,9 segundos. Conclusão: O gerenciamento dos alarmes desses equipamentos torna-se imprescindível para minimizar a ocorrência do fenômeno fadiga de alarmes e na oferta de uma assistência mais segura ao paciente dependente dessa tecnologia.