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. 2025 Jul 1;24(1):815.
doi: 10.1186/s12912-025-03500-3.

The effect of a clinical approach to ventilator alarm management on alarm fatigue in intensive care nurses: a randomized controlled trial

Amirhossein Nasirmoghadas  1 , Atefe Salimi Akinabadi  1   2 , Yekta Rahimi  3 , Neda Sanaie  4 , Ladan Sedighi  5
Affiliations

The effect of a clinical approach to ventilator alarm management on alarm fatigue in intensive care nurses: a randomized controlled trial

Amirhossein Nasirmoghadas et al. BMC Nurs. .

Abstract

Background: Every day in intensive care units (ICUs), many alarms from several devices -especially ventilators- are generated, creating a noisy environment, which is on the top of technology-related hazards and may lead to alarm fatigue among nurses. This study aimed to investigate the impact of a clinical approach to ventilator alarm management on nurses' alarm fatigue and alarm frequency in ICUs.

Methods: This randomized controlled trial involved 75 nurses in two general ICUs allocated into control and intervention groups using cluster randomization. In the intervention group (IG), clinical causes and solutions of common ventilator alarms were trained in a 4-hour online webinar. Then, an evidence-based guideline for alarm management was attached to all ventilators in the intervention ICU. Additionally, nurses of the IG were trained virtually and face-to-face regarding the fundamentals of mechanical ventilation and how to manage ventilator alarms for one month. Before and after the intervention, nurses' alarm fatigue and frequency of three common alarms were recorded for five consecutive days. The control group (CG) did not receive the educational content. Data were analyzed using SPSS-26. This study adheres to CONSORT guidelines.

Results: The baseline characteristics were not significantly different between the groups. Also, alarm fatigue scores of nurses did not significantly differ between groups before the intervention (p = 0.17). In the IG, nurses' alarm fatigue scores significantly decreased from 24.86 ± 6.65 to 20.24 ± 4.39 (p < 0.025) and its difference was significant between the groups (p < 0.001). However, alarm fatigue scores in the CG did not improve significantly after one month. As a secondary outcome, the frequency of three common alarms including high pressure (-34.3%), high minute volume/tidal volume (-28.6%), and high respiratory rate (-25.4%) was reduced after the intervention.

Conclusion: This study indicated that training and implementing an evidence-based clinical approach to ventilator alarm management not only reduced nurses' alarm fatigue but also could lead to a significant reduction in the common ventilator alarms frequency.

Trial registration: This study was prospectively registered by the Iranian Registry of Clinical Trials ( https://irct.behdasht.gov.ir/ ) on 01/09/2024 with registration ID: IRCT20240306061197N2.

Keywords: Alarm fatigue; Alarm management; Evidence-based practice; Intensive care units; Mechanical ventilation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical permissions for this study were issued by the Research Ethics Committees of the Vice-Chancellor in Research Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran, in August 2024 (approval ID: IR.SBMU.RETECH.REC.1403.231). The investigation conforms with the principles of the “Declaration of Helsinki”. Written informed consent was obtained from participants. They could withdraw from the study at any time without any consequences. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participants recruitment flowchart
Fig. 2
Fig. 2
Alarm fatigue scores before and after the intervention in the two groups
See this image and copyright information in PMC

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