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The Role of Clinical Decision Support Tools to Reduce Blood Pressure Variability in Critically Ill Patients Receiving Vasopressor Support

GIULIANO, KAREN K. PhD, RN, FAAN; JAHRSDOERFER, MARY MHA, RN; CASE, JODY RN; DREW, TARA RN; RABER, GREG BSE

CIN: Computers, Informatics, Nursing:
doi: 10.1097/NCN.0b013e3182418c39
Feature Article
Abstract

Current monitoring systems for patients receiving vasopressor support generally rely on bedside monitors with audible alarms that are activated when blood pressure declines below pre-established thresholds, which can result in fluctuations that may increase risk of myocardial ischemia. This pilot study evaluated the effects of three bedside monitors on mean arterial blood pressure and percentage of time at mean arterial pressure among critically ill patients. The monitors were the standard display with audible alarm or one of two types of clinical decision support systems including Intellivue Horizon Trends (Philips Healthcare, Andover, MA) and Horizon Trends and ST Map (Philips Healthcare). Patients in the two groups monitored with Horizon Trends had significantly higher mean arterial pressure (72.8 ± 7.0 mm Hg) compared with those monitored with the standard monitor (68.1 ± 6.8 mm Hg; P= .004). Patients monitored with Horizon Trends also spent a significantly higher percentage of time within their target mean arterial pressure range compared with those in the standard monitor group (P = .031). These findings suggest that further study is needed to assess the impact of clinical decision support tools on management of blood pressure variability in critically ill patients receiving vasopressor therapy.

Author Information

Author Affiliations: Patient Care & Clinical Informatics, Philips Healthcare, Andover, MA (Dr Giuliano, Ms Jahrsdoerfer, and Mr Raber); and Intensive Care Unit, Concord Hospital, Concord, NH (Mss Case and Drew).

Philips Healthcare funded this study by providing (1) the Horizon Trends and ST Map software to existing Philips bedside monitors in the ICU at Concord Hospital, (2) educating clinical staff regarding usage of these clinical decision support tools, and (3) providing support for the data collection, data analysis, and preparation of this article.

Corresponding author: Mary Jahrsdoerfer, MHA, RN, Patient Care & Clinical Informatics, Philips Healthcare, 3000 Minuteman Rd, MS 0458, Andover, MA 01810 (mary.jahrsdoerfer@philips.com).

© 2012 Lippincott Williams & Wilkins, Inc.