Cardiorespiratory Patterns During Alarms in Infants Using Apnea/Bradycardia Monitors

Nathanson, Ian

doi:10.1001/archpedi.1989.02150160106021

Cited by 13 publications

(16 citation statements)

References 14 publications

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“…One of the major concerns of home monitoring is the occurrence of false alarms [9,10,15,16]. Such alarms not only cause distress and anxiety in concerned parents [11] but also lead to unnecessarily prolonged duration of monitoring and additional costs.…”

Section: Discussionmentioning

confidence: 99%

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Short-term event recording as a measure to rule out false alarms and to shorten the duration of home monitoring in infants

Zotter

Kurz

et al. 2003

Wien Klin Wochenschr

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Apnea and cardiorespiratory home monitors are commonly used for electronic surveillance of infants. Frequent alarms can be very stressful for parents and lead to unnecessarily prolonged home monitoring. The aims of this study were to determine the frequency and type of significant events by using short-term home event recordings of respiratory, electrocardiogram and oxygenation patterns, to consider the pros and cons of oxygenation recording, to correlate the findings with observations made by parents and to find out whether parents could be reassured by the use of these monitors. We investigated recordings from 26 healthy symptomless infants (14 male, 12 female) whose parents experienced anxiety and stress owing to frequent alarms on their apnea (n = 2) or cardiorespiratory home monitors (n = 24). 770 events were analyzed and compared with the parents' interpretation. Median duration of monitoring was 10 days. Only 39/770 alarms (5.1%) were classified as true alarms. Of these, 30 alarms (76.9%) were misinterpreted as false alarms by parents. In contrast, of 218 alarms regarded as true by parents only 15 (6.9%) were in fact true, alarms. The comparison of monitor data and the parents' reports showed no correlation in interpretation of alarms, for both true (r = 0.06) and false alarms (r = -0.09). Of 283 oxygenation alarms, only two were due to real desaturation. Following short-term monitoring, 21/26 parents (80.7%) declared they were reassured. Monitoring could immediately be discontinued in 17/26 infants (65.4%). Short-term event recording can clarify the significance of frequent alarms, reassure parents and shorten the duration of home monitoring.

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Section: Discussionmentioning

confidence: 99%

“…Event-recorder cardiorespiratory monitors have been available for several years. These allow the identification of infants having true events and help to define more precisely the population at risk for significant events [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Short-term event recording as a measure to rule out false alarms and to shorten the duration of home monitoring in infants

Zotter

Kurz

et al. 2003

Wien Klin Wochenschr

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“…Cardiorespiratory event recording studies have documented that parents tend to report false alarms as clinically significant events (KRONGRAD and O'NEILL, 1986;STEINSCHNEIDER and SANTOS, 1991 ). Use of the cardiorespiratory event recording has been quite helpful in distinguishing apnoea and bradycardia from false alarms due to equipment malftmction (WEESE-MAYER et al, 1989;1990;NATHANSON et al, 1989). Studies on hospitalised infants have found that nursing logs tend to underreport the true frequency of apnoea and bradycardia (SOUTHALL et al, 1983;MUTTITT et al, 1988).…”

Section: Before Audible Bradvcardia Alarm (A) Il~ant Was Awake Vocamentioning

confidence: 99%

“…Most recently, infant cardiorespiratory monitors have included an event capture capability that allows the physician to view the electrocardiogram, heart rate and transthoracic impedance signals for a short period of time before, during and after an alarm. Such 'event recording' or 'documented monitoring' has been effective in distinguishing true from false alarms and in documenting compliance with monitor usage (WEESE-MAYER et al, 1989;1990;NATHANSON et aL, 1989;SILVESTRI et al, 1995;COTE et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Computerised audiovisual event recording for infant apnoea and bradycardia

Brouillette

Tsirigotis

Leimanis

et al. 2000

Med. Biol. Eng. Comput.

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Event recording, by differentiating between true and false events, has advanced the diagnosis and management of infants on home cardiorespiratory monitors; however, the pathogenesis of many events remains obscure. To clarify infant behaviours around the time of apnoea/bradycardia alarms, a computerised audiovisual event recording system (CAVERS) triggered by the apnoea/bradycardia recorder, has been developed. The audiovisual recording can begin up to 3 min before the alarm and can continue for up to 3 min after the alarm. CAVERS information is recorded for a total of 65 events in 13 infants. The CAVERS proves most helpful in documenting infant position and the wide variety of behaviours associated with bradycardic events. These behaviours range from sleep or quiet wakefulness to crying and generalised movements. Post-event activity is also highly variable. Interestingly, 20 of 65 events appear to terminate when the infant wakes to the audible monitor alarm. Nursing intervention is documented for 14 of 42 bradycardic events but only one of 23 apnoeic events. The CAVERS, by elucidating infant behaviours, provides information complementary to that given by cardiorespiratory event recording. It is suggested that infant monitors of the future should incorporate both audiovisual and cardiorespiratory data to elucidate optimally apparent life-threatening events, apnoeas and bradycardias.

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“…Furthermore, there are still many infants for whom monitoring is recommended. 3 Monitors equipped with memory have been shown to be useful, not only to distinguish true from false alarms and document the nature of cardiorespiratory events that occur in the home [4][5][6][7] but also to document the hours the monitor was in use. [7][8][9] As part of a multicenter collaborative study (CHIME), a state-of-the-art home monitor (Non-Invasive Monitoring Systems Inc, Miami Beach, Fla) was developed to assess breathing, heart rate, hemoglobin saturation, body position, and the precise time when the monitor was in use.…”

mentioning

confidence: 99%