title: Benefits of smart pumps for automated changeovers of vasoactive drug infusion pumps: a quasi-experimental study.
abstract: BACKGROUND
  Manual changeover of vasoactive drug infusion pumps (CVIP) frequently lead to haemodynamic instability. Some of the newest smart pumps allow automated CVIP. The aim of this study was to compare automated CVIP with manual 'Quick Change' relays.
  
  
  METHODS
  We performed a prospective, quasi-experimental study, in a university-affiliated intensive care unit (ICU). All adult patients receiving continuous i.v. infusion of vasoactive drugs were included. CVIP were successively performed manually (Phase 1) and automatically (Phase 2) during two 6-month periods. The primary endpoint was the frequency of haemodynamic incidents related to the relays, which were defined as variations of mean arterial pressure >15 mm Hg or heart rate >15 bpm. The secondary endpoints were the nursing time dedicated to relays and the number of interruptions in care because of CVIP. A multivariate mixed effects logistic regression was fitted for analytic analysis.
  
  
  RESULTS
  We studied 1329 relays (Phase 1: 681, Phase 2: 648) from 133 patients (Phase 1: 63, Phase 2: 70). Incidents related to CVIP decreased from 137 (20%) in Phase 1 to 73 (11%) in Phase 2 (P<0.001). Automated relays were independently associated with a 49% risk reduction of CVIP-induced incidents (adjusted OR=0.51, 95% confidence interval 0.34-0.77, P=0.001). Time dedicated to the relays and the number of interruptions in care to manage CVIP were also significantly reduced with automated relays vs manual relays (P=0.001).
  
  
  CONCLUSIONS
  These results demonstrate the benefits of automated CVIP using smart pumps in limiting the frequency of haemodynamic incidents related to relays and in reducing the nursing workload.
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, F-69003 Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Cour
authors.forename: R
authors.initials: R
authors.lastname: Hernu
authors.forename: T
authors.initials: T
authors.lastname: Bénet
authors.forename: J M
authors.initials: JM
authors.lastname: Robert
authors.forename: D
authors.initials: D
authors.lastname: Regad
authors.forename: B
authors.initials: B
authors.lastname: Chabert
authors.forename: A
authors.initials: A
authors.lastname: Malatray
authors.forename: S
authors.initials: S
authors.lastname: Conrozier
authors.forename: P
authors.initials: P
authors.lastname: Serra
authors.forename: M
authors.initials: M
authors.lastname: Lassaigne
authors.forename: P
authors.initials: P
authors.lastname: Vanhems
authors.forename: L
authors.initials: L
authors.lastname: Argaud
mesh_terms: D000328:Adult; D000368:Aged; D001331:Automation; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D017052:Hospital Mortality; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous / Q000295:instrumentation* / Q000379:methods*; D007362:Intensive Care Units / Q000458:organization & administration; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009726:Nurses; D011446:Prospective Studies; D012769:Shock / Q000628:therapy; D013594:Syringes; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000078329:Workforce; D016526:Workload
chemical_list: D014662:Vasoconstrictor Agents
keywords: care workload; critical care nursing; shock; smart pumps; vasoactive drugs