ArticleCritical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine2026
Alarm configuration and adherence to prescribed mean arterial pressure targets in the intensive care unit: A multicentre pre-post evaluation.
Article in Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Objective: To evaluate whether structured education combined with target-aligned arterial pressure alarm limits improved alignment between documented achieved and clinician-prescribed mean arterial pressure (MAP) during vasopressor therapy. Design: Multicentre pre-post quality-improvement evaluation. Setting: Three tertiary intensive care units in Australia and New Zealand. Participants: Adult intensive care unit patients receiving continuous vasopressor infusion with invasive arterial pressure monitoring, a documented clinician-prescribed MAP target, and available MAP and alarm-limit data during 24 h of vasopressor therapy. Intervention: A centre-level bundled implementation strategy comprising structured education, target-aligned arterial pressure alarm-limit configuration, and bedside implementation support, without mandating MAP targets or altering prescribing practice. Main outcome measures: The primary outcome was MAP gap, defined as documented achieved MAP minus prescribed MAP at four-hourly observation points during vasopressor therapy. Secondary outcomes included alarm window configuration, inter-site variation in MAP gap, exposure to MAP <60 mmHg, and exploratory short-term clinical outcomes. Results: After the intervention, alarm window width was narrower and more consistently aligned with prescribed MAP targets (median difference in width -40 mmHg, 95% confidence interval [CI]: -45 to -35). The post-intervention phase was associated with a lower documented MAP gap (median difference: -4 mmHg, 95% CI: -5.0 to -3.0; p < 0.001), reflecting reduced overshoot above target. The proportion of observations with MAP <60 mmHg did not increase. Clinical outcome data were exploratory and incompletely captured. Conclusions: Structured education combined with target-aligned arterial pressure alarm limits and bedside implementation support was associated with improved alignment between documented achieved and clinician-prescribed MAP. Further evaluation should include continuous pressure-time exposure, vasopressor dose, alarm burden, and longitudinal adherence to target-aligned alarm limits.
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