Integrated pulmonary index during procedural sedation and analgesia: A cluster-randomized trial.
Aaron Conway, Mohammad Goudarzi Rad, Kristina Chang and 2 others
PMID 38924169WHAT IT FOUND
Enabling the Integrated Pulmonary Index did not reduce the time alarms ran before nurses intervened during nurse-administered sedation.
In patients who desaturated, oxygen desaturation burden was lower, but this was a secondary finding.
Key findings
01Enabling the IPI did not significantly reduce the number of seconds alarms ran before a nurse intervened (incidence rate ratio 1.71; 95% CI 0.96 to 3.06).
02Desaturation events were uncommon, but among patients who had one, the IPI-enabled group had lower area under the oxygen saturation below 90% curve (β = -0.73; 95% CI -1.32 to -0.14).
03The IPI-enabled group had more inappropriate alarms, defined as alarms silenced without intervention (incidence rate ratio 13.13; 95% CI 1.4 to 122.95), though the estimate was imprecise.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 11 nurses were randomized, far fewer than the planned 40 clusters, so the trial may have been too small to detect a difference. Nurses and the research assistant were not blinded to allocation. Alarm thresholds were not pre-specified and were chosen by nurses, so settings may vary by practice. Sedation doses were small, with median 1 mg midazolam and 50-75mcg fentanyl, so results may not apply to deeper sedation. Desaturation events were uncommon, so the secondary oxygen desaturation result is less stable. The inappropriate alarm estimate was very imprecise. Two patients in the IPI-enabled group did not receive the allocated intervention, and 11 patients were excluded because they did not receive sedation.
Declared interests
Funded by the Medtronic External Research Program. The authors declared no conflicts of interest and stated the funder had no role in design, conduct, analysis, interpretation, writing, or submission.
The easy way to misread this
Do not conclude that enabling the IPI makes sedation safer because the oxygen desaturation area was lower. That was a secondary outcome, desaturation events were uncommon, and the primary alarm-response outcome was null.