Premature ventricular complexes during continuous electrocardiographic monitoring in the intensive care unit: Occurrence rates and associated patient characteristics

• Published in: Journal of clinical nursing 2023-07, Vol.32 (13-14), p.3469-3481
• Main Authors: Suba, Sukardi, Hoffmann, Thomas J., Fleischmann, Kirsten E., Schell‐Chaple, Hildy, Prasad, Priya, Marcus, Gregory M., Badilini, Fabio, Hu, Xiao, Pelter, Michele M.
• Format: Article
• Language: English
• Subjects: alarm fatigue; Alarms; arrhythmia; clinical alarm; electrocardiographic monitoring; Electrocardiography; Hyperkalemia; Intensive care; intensive care unit; Patient safety; premature ventricular complex; Vital signs
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.16408

Aims and objectives This study examined the occurrence rate of specific types of premature ventricular complex (PVC) alarms and whether patient demographic and/or clinical characteristics were associated with PVC occurrences. Background Because PVCs can signal myocardial irritability, in‐hospital electrocardiographic (ECG) monitors are typically configured to alert nurses when they occur. However, PVC alarms are common and can contribute to alarm fatigue. A better understanding of occurrences of PVCs could help guide alarm management strategies. Design A secondary quantitative analysis from an alarm study. Methods The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. Seven PVC alarm types (vendor‐specific) were described, and included isolated, couplet, bigeminy, trigeminy, run PVC (i.e. VT >2), R‐on‐T and PVCs/min. Negative binomial and hurdle regression analyses were computed to examine the association of patient demographic and clinical characteristics with each PVC type. Results A total of 797,072 PVC alarms (45,271 monitoring hours) occurred in 446 patients, including six who had disproportionately high PVC alarm counts (40% of the total alarms). Isolated PVCs were the most frequent type (81.13%) while R‐on‐T were the least common (0.29%). Significant predictors associated with higher alarms rates: older age (isolated PVCs, bigeminy and couplets); male sex and presence of PVCs on the 12‐lead ECG (isolated PVCs). Hyperkalaemia at ICU admission was associated with a lower R‐on‐T type PVCs. Conclusions Only a few distinct demographic and clinical characteristics were associated with the occurrence rate of PVC alarms. Further research is warranted to examine whether PVCs were associated with adverse outcomes, which could guide alarm management strategies to reduce unnecessary PVC alarms. Relevance to clinical practice Targeted alarm strategies, such as turning off certain PVC‐type alarms and evaluating alarm trends in the first 24 h of admission in select patients, might add to the current practice of alarm management.