A randomized, controlled trial of computerized physiologic trend monitoring in an intensive care unit

S Cunningham, S Deere, A Symon, R A Elton, N McIntosh

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To assess whether the provision of computerized physiologic trend data could improve outcome in newborn infants requiring intensive care.

DESIGN: Randomized, controlled trial, with subsidiary questionnaire studies.

SETTING: Tertiary neonatal intensive care unit with 12 intensive care cots.

PATIENTS: All infants admitted between January 1991 and September 1993 who were < or =32 wks gestation or >32 wks gestation, and ventilated for >4 hrs or asphyxiated.

INTERVENTIONS: Randomization to one of four groups for first 7 days of life: A) no display of trend data; B) continuous display of trend data; C1) alternating 24-hr display of trend data, starting with display in first 24 hrs; and C2) alternating 24-hr display of trend data, starting with no display in first 24 hrs.

MEASUREMENTS AND MAIN RESULTS: The short-term effects of monitoring on patient outcome was judged by volume of colloid given, number of blood gases taken, and by measurement taken from cranial Doppler ultrasound. Medium-term measures included time ventilated, time given supplemental oxygen, death, time to death or discharge, and cranial ultrasound at discharge. Long-term outcome was assessed by neurodevelopmental status at age 1 to 4 yrs of age. Staff and parent questionnaires assessed their respective attitudes to the introduction of this technology. None of the patient outcome measures, short-, medium-, or long-term, demonstrated any significant benefit from the provision of computerized physiologic trend monitoring. Staff questionnaires demonstrated an acceptance of the system and an improved understanding of neonatal physiology as a result of computerized physiologic trends. Parent questionnaires demonstrated increased anxiety caused by the system in 11% of parents, although only 1% of parents continued to have concerns if the system were able to help their child.

CONCLUSIONS: A randomized, controlled trial was unable to demonstrate any benefit to patients resulting from the introduction of a computerized physiologic trend monitoring system. Benefits of the system have been recognized, however, in subsidiary studies, staff education, and research studies.

Original languageEnglish
Pages (from-to)2053-60
Number of pages8
JournalCritical Care Medicine
Volume26
Issue number12
Publication statusPublished - Dec 1998

Keywords

  • Attitude of Health Personnel
  • Attitude to Health
  • Child, Preschool
  • Developmental Disabilities
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Intensive Care, Neonatal
  • Monitoring, Physiologic
  • Outcome Assessment (Health Care)
  • Parents
  • Scotland
  • Signal Processing, Computer-Assisted
  • Surveys and Questionnaires
  • Time Factors

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