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October 17-21, 2009 New Orleans, LA Home Abstract Archive Search Abstracts 2009 Session Grid 2009 Meeting Website Policy Statements ASA Website Feedback 
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A403
October 18, 2009 9:00 AM - 11:00 AM Room Area F |
| Evaluation of a Sodium-Nitroprusside Titration Support System |
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* Matthias Görges, M.S., Dwayne R. Westenskow, Ph.D., Joseph A. Orr, Ph.D. Department of Anesthesiology, University of Utah, Salt Lake City, Utah |
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Introduction: Vasoactive drug infusion rates are titrated to achieve a desired effect, e.g. a certain mean arterial pressure (MAP), rather than using standardized infusion rates. Additionally, there is a time delay between the change in an infusion rate and the subsequent change in the patient's vital signs, requiring significant nursing time to titrate the infusion rate until the desired effect is achieved. Automated systems have been developed to manage this control task; however these systems have not been adopted clinically. The purpose of this study is to evaluate whether an advisory system that predicts for blood pressure values five minutes in the future enhances a nurse's ability to manage Sodium-Nitroprusside (SNP) infusion rates.
Methods: After obtaining IRB approval, informed consent was obtained from 9 medical intensive care unit nurses. They were presented with six scenarios in random order, in which they were asked to control the MAP of the simulated patients to a new level by changing the SNP infusion rate. In half of the scenarios they were provided with a decision support tool stating the patient's sensitivity as well as showing a 5 minute prediction of the MAP. Participants were encouraged to reach the target MAP with a minimal number of infusion rate changes and in the shortest amount of time. A repeated measure 2-way ANOVA was used to analyze times to reach the titration goal and the number of infusion rate changed required to do so.[figure1]Results: The median age of the 9 nurses (3 males) was 29 years (range 25-63 years) with 3 years (range 1-19 years) of ICU experience. Nurses required 4 infusion rate changes (range 1-7) to reach the titration goal with the decision support tool and 6 without (range 1-41). Significant differences (p=0.0017, F=34.19) for the decision support effect as well as significant effect of participants (p=0.0015, F=1.087) were found. The median time to reach the titration goal was 4.1 minutes (range 1.6-7.8 minutes) for nurses with decision support and 10.2 minutes (range 4.1-26.8 minutes) without decision support. Significant differences (p=3*10-6, F=30.55) for the decision support effect and no effect of participants (p=0.79) were observed.[figure2]Discussion: A significant improvement was found in both the time to reach the MAP goal as well as the number of infusion rate changes required to reach the target MAP. With nurses needing to attend to two patients, the proposed decision support might be able to increase patient safety and reduce workload twofold: first by enabling nurses to reach a desired blood pressure more quickly, with only some minor fine-tuning at the end, and second by allowing the nurse to attend to tasks other than blood pressure titration. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |
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