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

Objective: To assess whether the provision of computerized physiologic tren d 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 less than or equal to 32 wks gestation or >32 wks gestation, and venti lated 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) alt ernating 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 pati ent outcome was judged by volume of colloid given, number of blood gases ta ken, and by measurement taken from cranial Doppler ultrasound. Medium-term measures included time ventilated, time given supplemental oxygen, death, t ime to death or discharge, and cranial ultrasound at discharge. Long-term o utcome 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, demonst rated any significant benefit from the provision of computerized physiologi c 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 increas ed anxiety caused by the system in 11% of parents, although only 1% of pare nts continued to have concerns if the system were able to help their child. Conclusions: A randomized, controlled trial was unable to demonstrate any b enefit to patients resulting from the introduction of a computerized physio logic trend monitoring system. Benefits of the system have been recognized, however, in subsidiary studies, staff education, and research studies.