Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form

Cardiorespiratory instability before and after implementing an integrated monitoring system

Hravnak, M and Devita, MA and Clontz, A and Edwards, L and Valenta, C and Pinsky, MR (2011) Cardiorespiratory instability before and after implementing an integrated monitoring system. Critical Care Medicine, 39 (1). 65 - 72. ISSN 0090-3493

[img] Plain Text (licence)
Available under License : See the attached license file.

Download (1kB)

Abstract

Objectives: Cardiorespiratory instability may be undetected in monitored step-down unit patients. We explored whether using an integrated monitoring system that continuously amalgamates single noninvasive monitoring parameters (heart rate, respiratory rate, blood pressure, and peripheral oxygen saturation) into AN instability index value (INDEX) correlated with our single-parameter cardiorespiratory instability concern criteria, and whether nurse response to INDEX alert for patient attention was associated with instability reduction. Design: Prospective, longitudinal evaluation in sequential 8-, 16-, and 8-wk phases (phase I, phase II, and phase III, respectively). Setting: A 24-bed trauma step-down unit in single urban tertiary care center. Patients: All monitored patients. Interventions: Phase I: Patients received continuous single-channel monitoring (heart rate, respiratory rate, blood pressure, and peripheral oxygen saturation) and standard care; INDEX background was recorded but not displayed. Phase II: INDEXwas background-recorded; staff was educated on use. Phase III: Staff used a clinical response algorithm for INDEXalerts. Measurement and main results: Any monitored parameters even transiently beyond local cardiorespiratory instability concern triggers (heart rate of <40 or >140 beats/min, respiratory rate of <8 or >36 breaths/min, systolic blood pressure of <80 or >200 mm Hg, diastolic blood pressure of >110 mm Hg, and peripheral oxygen saturation of <85%) defined INSTABILITYmin. INSTABILITYmin further judged as both persistent and serious defined INSTABILITYfull. The INDEX alert states were defined as INDEXmin and INDEXfull by using same classification. Phase I and phase III admissions (323 vs. 308) and monitoring (18,258 vs. 18,314 hrs) were similar. INDEXmin and INDEXfull correlated significantly with INSTABILITYmin and INSTABILITYfull (r = .713 and r = .815, respectively, p < .0001). INDEXmin occurred before INSTABILITYmin in 80% of cases (mean advance time 9.4 ± 9.2 mins). Phase I and phase III admissions were similarly likely to develop INSTABILITYmin (35% vs. 33%), but INSTABILITYmin duration/admission decreased from phase I to phase III (p = .018). Both INSTABILITYfull episodes/admission (p = .03) and INSTABILITYfull duration/admission (p = .05) decreased in phase III. Conclusion: The integrated monitoring system INDEX correlated significantly with cardiorespiratory instability concern criteria, usually occurred before overt instability, and when coupled with a nursing alert was associated with decreased cardiorespiratory instability concern criteria in step-down unit patients. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.


Share

Citation/Export:
Social Networking:
Share |

Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Hravnak, Mmhra@pitt.eduMHRA
Devita, MA
Clontz, A
Edwards, L
Valenta, C
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 1 January 2011
Date Type: Publication
Journal or Publication Title: Critical Care Medicine
Volume: 39
Number: 1
Page Range: 65 - 72
DOI or Unique Handle: 10.1097/ccm.0b013e3181fb7b1c
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0090-3493
PubMed ID: 20935559
Date Deposited: 07 Mar 2012 20:40
Last Modified: 22 Jun 2021 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/11360

Metrics

Monthly Views for the past 3 years

Plum Analytics

Altmetric.com


Actions (login required)

View Item View Item