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

Crit Care Med. 1998 Dec;26(12):2053-60. doi: 10.1097/00003246-199812000-00040.

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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

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