Alarm configuration and adherence to prescribed mean arterial pressure targets in the intensive care unit: A multicentre pre-post evaluation.

OBJECTIVE

To evaluate whether structured education combined with target-aligned arterial pressure alarm limits improved alignment between documented achieved and clinician-prescribed mean arterial pressure (MAP) during vasopressor therapy.

DESIGN

Multicentre pre-post quality-improvement evaluation.

SETTING

Three tertiary intensive care units in Australia and New Zealand.

PARTICIPANTS

Adult intensive care unit patients receiving continuous vasopressor infusion with invasive arterial pressure monitoring, a documented clinician-prescribed MAP target, and available MAP and alarm-limit data during 24 h of vasopressor therapy.

INTERVENTION: A centre-level bundled implementation strategy comprising structured education, target-aligned arterial pressure alarm-limit configuration, and bedside implementation support, without mandating MAP targets or altering prescribing practice.

MAIN OUTCOME MEASURES: The primary outcome was MAP gap, defined as documented achieved MAP minus prescribed MAP at four-hourly observation points during vasopressor therapy. Secondary outcomes included alarm window configuration, inter-site variation in MAP gap, exposure to MAP <60 mmHg, and exploratory short-term clinical outcomes.

RESULTS

After the intervention, alarm window width was narrower and more consistently aligned with prescribed MAP targets (median difference in width -40 mmHg, 95% confidence interval [CI]: -45 to -35). The post-intervention phase was associated with a lower documented MAP gap (median difference: -4 mmHg, 95% CI: -5.0 to -3.0; p < 0.001), reflecting reduced overshoot above target. The proportion of observations with MAP <60 mmHg did not increase. Clinical outcome data were exploratory and incompletely captured.

CONCLUSIONS

Structured education combined with target-aligned arterial pressure alarm limits and bedside implementation support was associated with improved alignment between documented achieved and clinician-prescribed MAP. Further evaluation should include continuous pressure-time exposure, vasopressor dose, alarm burden, and longitudinal adherence to target-aligned alarm limits.