Clinical Alarm Bibliography


(Health care articles with "alarm" in their title.)

___, Evaluation of ventilator alarms. J Med Eng Technol 1984; 8:270-276

___, The report of the expert working group on alarms on clinical monitors. In: Response to Recommendation 11 of the Clothier Report: The Allitt Inquiry. Medical Devices Agency, Feb. 1995 (England)

Ahlborn V, Bohnhorst B, Peter CS, Poets CF. False alarms in very low birthweight infants: comparison between three intensive care monitoring systems. Acta Paediatr. 2000;89:571-576

Arrabito GR, Mondor T, Kent K. Judging the urgency of non-verbal auditory alarms: a case study. Ergonomics 2004;47:821-840

Asbury A, Rolly G: Theatre monitor alarm settings: a pilot survey in Scotland and Belgium. Anaesthesia 1999;54:176-180

Becker K, Rau G, Kaesmacher H, Petermeyer M, Kalff G, Zimmerman H. Fuzzy logic approaches to intelligent alarms. IEEE/EMBS Mag 1994;13:710-716

Beneken J, van der Aa J. Alarms and their limits in monitoring. J Clin Monit 1989;5:205-210

Beneken JEW, Gravenstein JS. Sophisticated alarms in patient monitoring: a methodology based on systems engineering concepts. In: Gravenstein JS, Newbower RS, Ream AK, Smith NT. eds. The automated anesthesia record and alarm systems. Boston: Butterworth. 1987:211-228

Benis AM, Fitzkee HL, Jurado RA, Litwak RS. Improved detection of adverse cardiovascular trends with the use of a two-variable computer alarm. Crit Care Med 1980;8:341-344

Bethune DW, Burns A. A user-friendly disconnection alarm. Br J Anaesth 1990;65:595

Beydon L. Do away with alarms or make them intelligent? Ann Fr Anesth Reanim 2001;20:667-668

Biot L, Carry PY, Perdrix JP, Eberhard A, Baconnier P. Clinical evaluation of alarm efficiency in intensive care. Ann Fr Anesth Reanim 2000;19:459-466

Biot L, Holzapfel L, Becq G, Melot C, Baconnier P. Do we need a systematic activation of alarm soundings for blood pressure monitoring for the safety of ICU patients? J Crit Care 2003;18:212-216

Bleicher W, Epple E. Thoughts on alarm processing in intensive care medicine and anesthesia monitoring. Anasth Intensivther Notfallmed 1986;21:132-136

Bliss JP, Acton SA. Alarm mistrust in automobiles: how collision alarm reliability affects driving. Appl Ergon 2003;34:499-509

Bliss JP, Gilson RD, Deaton JE. Human probability matching behavior in response to alarms of varying reliability. Ergon 1995;38:2300-2313

Bliss J, Dunn M, Fuller BS. Reversal of the cry-wolf effect: An investigation of two methods to increase alarm response rates. Perceptual and Motor Skills 1995;80:1231-1242

Block FE Jr, Detko GJ Jr. Minimizing interference and false alarms from electrocautery in the Nellcor N-100 pulse oximeter. J Clin Monit 1986;2:203-205

Block FE Jr. Evaluation of users' abilities to recognize musical alarm tones. J Clin Monit. 1992;8:285-290

Block FE. Jr, Schaaf C. Auditory Alarms during anesthesia monitoring with an integrated monitoring system. Int J Clin Monit Comput 1996;13:81-84

Block FE Jr, Nuutinen L, Ballast B. Optimization of alarms: a study on alarm limits, alarm sounds, and false alarms, intended to reduce annoyance. J Clin Monit Comput. 1999;15:75-83

Block FE, Rouse JD, Hakala M, Thompson, CL. A proposed new set of alarm sounds which satisfy standards and rationale to encode source information. J Clin Monit Comput 2000;16:541-546

Blum L. The man/machine interface in the operating room: An ergonomic approach to a rational alarm system. Operating Room and Intensive Care Alarms and information Transfer, ASTM STP 1992:1152:32-38

Bode B, Gross K, Rikalo N, Schwartz S, Wahl T, Page C, Gross T, Mastrototaro J. Alarms based on real-time sensor glucose values alert patients to hypo- and hyperglycemia: the guardian continuous monitoring system. Diabetes Technol Ther 2004;6:105-113

Bohnhorst B, Poets CF. Major reduction in alarm frequency with a new pulse oximeter. Intensive Care Med 1998;24:277-278


Bosque EM. Symbiosis of nurse and machine through fuzzy logic: improved specificity of a neonatal pulse oximeter Alarm. ANS Adv Nurs Sci 1995;18:67-75

Breznitz S. Cry wolf: The psychology of false alarms. Hillsdale, NJ: Lawrence Erlbaum Associates 1984

Brooks R, Thorpe R, Wilson J. A new method for defining and managing process alarms and for correcting process operation when an alarm occurs. J Hazard Mater 2004;11:169-174

Brunner JX, Westenskow DR, Zelenkov P. Prototype ventilator and alarm algorithm for the NASA space station. J Clin Monit 1989;5:90-99

Buckingham B, Block J, Burdick J, Kalajian A, Kollman C, Choy M, Wilson DM, Chase P. Diabetes Research in Children Network. Response to nocturnal alarms using a real-time glucose sensor. Diabetes Technol Ther 2005;7:440-447

Campbell RM, Sheikh A, Crosse MM. A study of the incorrect use of ventilator disconnection alarms. Anaesthesia 1996;51:369-370

Carstensen P. Clinical Alarm Systems Audio Conference, MEDSUN, 4/10/2003

Chambrin M. Alarms in the intensive care unit: how can the number of false alarms be reduced? Crit Care 2001;5:184-188

Chambrin M, Ravaux P, Calvelo-Aros D, Jaborska A, Chopin C, Boniface B. Multicentric study of monitoring alarms in the adult intensive care unit (ICU) descriptive analysis. Intensive Care Med 1999;25:1360-1366

Chen R, Connelly RR, Mantel N. Analyzing post-alarm data in a monitoring system in order to accept or reject the alarm. Stat Med 1993;12:1807-1812

Chui PT, Gin T. False alarms and the integrated alarm system: report of a potential hazard. Anesth Analg 1994;79:192-193

Crew AD, Stoodley KDC, Lu R, et al. Preliminary clinical trials of a computer-based cardiac arrest alarm. Intensive Care Med 1991;17:359-364

Cropp J, Wood L, Raney, ?.,Bredle, D. Name that tone: The proliferation of alarms in the intensive care unit. Chest 1994;105:1217-1220

Cust AE, Donovan TJ, Colditz PB. Alarm settings for the Marquette 8000 pulse oximeter to prevent hyperoxic and hypoxic episodes. J Paediatr Child Health 1999;35:159-162

Cyna A, Kulkarni V, Tunstall M, et al. AURA: A new respiratory monitor and apnoea alarms for spontaneously breathing patients. Br J Anesth 1991;67:341-345

Deller A, Schuhle B, Konrad F, Kilian J. Alarms of medical-technical equipment in the surgical intensive care unit. A prospective study. Anasth Intensivther Notfallmed. 1988;23:238-43

Derrick JL, Thompson CL, Short TG. The application of a modified proportional-derivative control algorithm to arterial pressure alarms in anesthesiology. 1998;14:41-47

Doll T, Folds D. Auditory signals in military aircraft: ergonomics principles versus practice. Applied Ergonomics 1986;17:257-264

Dyro J. Improving the effectiveness of clinical alarm systems: clinical engineering’s role, Clinical Alarm Systems Audio Conference, MEDSUN, 4/10/2003

ECRI. Should alarm settings be constantly displayed? Health Devices 19??;12:212-213

ECRI. Ventilation Alarms. Health Devices 1981;10:204-220

ECRI. Editorial: Critical alarms patients at risk. Health Devices 1987;16:39-44

ECRI. Step-down units and telemetry monitoring: optimizing utilization [guidance article]. Health Devices 1993;22:25-27

ECRI. Ambulatory telemetry arrhythmia monitoring systems [evaluation]. Health Devices 1994;23:267-305

ECRI. Loose-lead alarms resulting from dried-out disposable electrodes. Health Devices 1994;23:309-310

ECRI. Absence of alarm defaults on Hewlett-Packard M2300A digital telemetry central station monitors. Health Devices 1995;24:157-158

ECRI. Anesthesia systems [evaluation]. Health Devices 1996;25:158-211

ECRI. Critical alarms: patients at risk [guidance article]. Health Devices 1996;25:25-30

ECRI. False apnea alarm on a Protocol Propaq physiologic monitor. Health Devices 1997;26:473-474

ECRI. General-purpose infusion pump purchasing guide. Health Devices 1997;26:36-49

ECRI, General-purpose infusion pumps [evaluation]. Health Devices 1997;26:50-75

ECRI. Intensive care ventilators [evaluation]. Health Devices 1998;27:308-362

ECRI. Mis-set ventilator alarms can be lethal [hazard report]. Health Devices 1999; 28:165-166

ECRI. Physiologic monitoring systems [evaluation]. Health Devices 1999;28:6-77

ECRI. Next-generation pulse oximetry: focusing on Masimo's Signal Extraction Technology [evaluation]. Health Devices 2000;29:349-365

ECRI. Alarms; unnoticed or unheeded. ECRI Report. 2001.[Online]. Available:

ECRI. Critical alarm and patient safety: ECRI's guide to developing effective alarm strategies and responding to JCAHO's alarm safety goal. Health Devices 2002;31:397-417

ECRI. Alarm-enhancement systems for ventilators: problems with physiologic monitoring interfaces. Health Devices 2004;33:354-355

ECRI. Bed-exit alarms. A component (but only a component) of fall prevention. Health Devices 2004;33:157-168

Edworthy J. Urgency mapping in auditory warning signals. In: Stanton N, ed. Human Factors in Alarm Design. London: Taylor and Francis. 1984:15-31

Edworthy J, Loxley S, Dennis I. Improving' auditory warning design: relationship between warning sound parameters and perceived urgency. Human Factors 1991;33:205-231

Edworthy J, Meredith CS. Cognitive psychology and the design of alarm sounds. Med Eng Phys 1994;16:445-449

Edworthy J, Stanton N. A user-centered approach to the design and evaluation of auditory warning signals: 1. Methodology. Ergon 1995;38:2262-2281

Edworthy J, Meredith C. Influence of verbal labeling and acoustic quality on the learning and retention of medical alarms. International Journal of Cognitive Ergonomics 1997;1:229-243.

Epstein RA. The elusive "disconnect alarm" examined. APSF News 1988;16:38-40

Farrell RM, Orr JA, Kuck K, Westenskow D. Differential features for a neural network based anesthesia alarm system. Biomed Sci Instrum 1992;28:99-104

Finley G, Cohen A. Perceived urgency and the anaesthetist: responses to common operating room monitor alarms. Can J Anesth 1991;38:958-964

Fodor I, Bloomfield D, Fisher A, et al. A control-free ventilator alarm. Anaesthesia 1977;32:1026-1029

Fromm RE Jr, Campbell E, Schlieter P. Inadequacy of visual alarms in helicopter air medical transport. Aviat Space Environ Med 1995;66:784-786

Fukui J., An expert alarm system. In: Gravenstein JS, Newbower RS, Ream AK, Smith NT, eds. The automated anesthesia record and alarm systems. Boston: Butterworth. 1987:203-209

Fukui Y, Masuzawa T. Knowledge-based approach to intelligent alarms. J Clin Monit 1989;5:211-216

Garfinkel D, Matsiras PV, Lecky JH, et al. PONI: An intelligent alarm system for respiratory and circulation management in the operating rooms. In: Symposium on computer Applications in Medical Care. American Medical Informatics Association 1988:13-17

Gilson RD, Mouloua M, Graft AS, McDonald DP. Behavioral influences of proximal alarms. Hum Factors 2001;43:595-610

Glazener CM, Evans JH. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2001;(1):CD002911. Review. Update in: Cochrane Database Syst Rev. 2003;(2):CD002911

Griffith R, Raciot B. A survey of practicing anesthesiologists on auditory alarms in the operating room. Hedley Whyte J. ed: Operating Room and Intensive Care Alarms and Information Transfer. 1992:10-18

Hayes B. An alarming situation in intensive therapy unit. Int Care Med 1983;9:103

Hedley-Whyte J. Monitoring and alarms: philosophy and practice. Balliere Clin Anaes 1988;2:379-389

Hee H, Lim S, Tan S. Infusion technology: a cause for alarm. Paediatr Anaesth. 2002;12:780-785

Hellier E, Edworthy J. Quantifying the perceived urgency of auditory warnings. Canadian Acoustics, 1989;17:3-11

Hyman WA, Drinker P. Design of medical device alarm systems. Med Instrum 1983; 17:103-6

Hyman WA. Evaluation of alarm systems for medical equipment. J Clin Eng 1982; 7:223-227

Jain P. Silence of the (A) Larms, Indian Soc Crit Care Med.,

Jones D, Lawson A, Holland R. Integrated monitor alarms and 'alarm overload'. Anaesth Intensive Care 1991;19:101-102

Jorritsma FF, Gieles JPM, Blom JA, et al. Error detection in patient monitoring. Biomed Tech (Berlin) 1979;24:50-51 [suppl]

Kacmarek RM. Alarms. In: Tobin MJ, ed. Principles and practice of intensive care monitoring. New York: McGraw-Hill 1997:133-141

Kalogeropoulos D, Carson ER, Collinson PO. Clinical-HINTS: integrated intelligent ICU patient monitoring and information management system. Stud Health Technol Inform 1997;43:906-10 (Pt B)

Kerr JH, Hayes B. An alarming situation in the intensive therapy unit. Intensive Therapy Medicine 1983;9:103-104

Kerr JH. Warning devices. Brit J Anaesth 1985;57:696-708

Kerr JH. Alarms and excursions. Anaesthesia 1986;41:807-808

Kestin IG, Miller BR, Lockhart CH. Auditory alarms during anaesthesia monitoring. Anaesth 1988;69:106-109

Kitaevich Y, Marchevsky JG. Monitoring monitors. J Clin Eng 1987;12:379-382

Klaas M., Chen E. Early response to pulse oximetry alarms with telemetry. J Clin Monit 1994;10:178-180

Kopotic RJ, Mannino FL, Colley CD, Horning N. Display variability, false alarms, probe cautions, and recorder use in neonatal pulse oximetry. J Perinatol 1987;7:340-342

Koski EMJ, Makivirta A, Sukuvaara T, Aarnck K. Frequency and reliability of alarms in the monitoring of cardiac post operative patients. Int J Clin Monit Comput 1990;2:47-55

Koski EM, Makivirta A, Sukuvaara T, Kari A. Clinicians™ opinions on alarm limits and urgency of therapeutic responses. Int J Clin Monit Comput 1995;12:85-88

Koski EMJ, Sukuvaara T, Makivim et al. A knowledge-based alarm system for monitoring cardiac operating room patients-Assessment of clinical performance. Int J Clin Monit Comput 1994;11:79-83

Kunz J, Hilberman M. Alarm warnings using a respiratory monitoring system. In: Computers in Cardiology. IEEE Computer Soc, Long Beach, CA 1975; Wg 141 C736:217-219

Kunz JC. The occurrence of alarms in the ICU. San Francisco Institute of Medical Sciences Report, 1976

Kuntz E. Monitors help predict emergencies. Mod Healthcare 1979;9:70

Lamont H, Fairley H. A pressure sensitive ventilator alarm. Anesth 1965;26:359

Laroche C, Tran Quoc H, HrnI R, McDuff S. 'Detectsound': a computerized model for predicting the detectability of warning signals in noisy workplaces. Applied Acoustics 1991;32:193-214

Lawless S. Crying wolf: false alarms in a pediatric intensive care unit, Crit Care Med 1994;22;981-985

Lawrence JC. Breathing systems: Gas pressure monitoring and venting, ventilator monitors and alarms. Anesth Intens Care 1988;16:38-40

Leung Y, Smith S, Parker S, Martin R. Learning and retention of auditory warnings,

Loeb R, Jones B, Behrman K, Leonard R. Anesthetists cannot identify audible alarms, Anesth 1990;72:A538

Loeb RG, Jones BR, Leonard RA, Berman K. Recognition accuracy of current operating room alarms. Anesth Analg 1992;74:499-505

Lutter NO, Urankar S, Kroeber S. False alarm rates of three third-generation pulse oximeters in PACU, ICU and IABP patients. Anesth Analg 2002;94:S69-75

Makivirta A, Koski E, Kari A, Sukuvaara T. The median filter as a preprocessor for a patient monitor limit alarm system in intensive care. Comput 21 Methods Programs Biomed 1991;34:139-144

Makivirta A, Koski EM. Alarm-inducing variability in cardiac postoperative data and the effects of prealarm delay. J Clin Monit 1994;10:153-162

Makivirta A, Kari A, Koski E, Sukuvaara T. A novel limit alarmer for reliable intensive care monitoring. Proc. IEEE Computers in Cardiology, Jerusalem, Israel, Sept 19-22, New York: IEEE, 1989:233-236

Malviya S, Reynolds PI, Voepel-Lewis T, Siewert M, Watson D, Tait A., Remper, K. False alarms and sensitivity of conventional pulse oximetry versus the Masimo SET technology in the pediatric postanesthesia care unit. Anesth Analg. 2000;90:1336-1340

McIntyre JN. Ergonomics: anaesthetics' use of auditory alarms in the operating room. Int J Clin Monit Comput 1985;2:47-55

McIntyre JW, Nelson TM. Application of automated human voice delivery to warning devices in an intensive care unit: a laboratory study. Int J Clin Monit Comput. 1989;6:255-262

McIntyre J, Stanford L. Ergonomics and anaesthesia: Auditory alarm signals in the operating room. In. Droh R, Erdmann W, Spintge R. eds. Anaesthesia: Innovation in Management. New York: Springer-Verlay. 1985:81-86.

McNeal M. The five steps to integrated alarm management: Improving clinical decision-making and patient safety, Healthcare Technology Horizons 2005;_:5-8

McNeer RR, Bohorquez J, Senders J, Ozdamar, O, Barach P. Design and validation of auditory alarm displays that signal graded degrees of urgency. Anesth 2004;101:A562

Mee CL. Ventilator alarms: how to respond with confidence. Nursing 1995;25:60-64

Meijler A, Beneken J. Data acquisition and display: a system with centralized display, Automatic record keeping and intelligent alarms. In: Gravenstein JS, Newbower RS, Ream AK, Smith NT, eds. The automated anesthesia record and alarm systems. Boston: Butterworth. 1987:229-236

Meredith C, Edworthy J. Are there too many alarms in the intensive care unit? An overview of the problems. J Adv Nurs 1995;21:15-20

Meredith CS, Edworthy J. Sources of confusion in intensive therapy unit alarms. In. Stanton N. ed. Human Factors in Alarm Design. London: Taylor and Francis. 1994:207-221

Meyer J, Bitan Y. Why better operators receive worse warnings. Human Factors 2002;44: 343-354

Mitton M. Oxygen failure alarms. Anaesthesia 2003;58:389-390

Momtahan KC, Tansley BW. An ergonomic analysis of the auditory alarm signals in the operating room and recovery room. Annual Meeting Canadian Acoustical Association, Halifax, Nova Scotia, October 1989

Momtahan KC, Hetu R. Tansley B. Audibility and identification of auditory alarms in operating rooms and an intensive care unit. Ergon 1993;36:159-1176

Momtahan K. Mapping of psychoacoustic parameters to the perceived urgency of auditory warning signals. Unpublished master's thesis. Carleton University, Ottawa. Ontario, Canada.1990

Mondor TA, Finley GA. The perceived urgency of auditory warning alarms used in the hospital operating room is inappropriate. Can J Anaesth 2003;50:221-228

Morgan CJ, Takala J, DeBacker D, Sukuvaara T, Kari A. Definition and detection of alarms in critical care. Comput Methods Programs Biomed. 1996;51:5-11

Morris R, Montano S. Response times to visual and auditory alarms during anaesthesia, Anesth & Intensive Care 1996;24:682-684

Murff HJ, Gosbee JW, Bates DW. Refining the performance of medical device alarms (Subchapter 41.2). Human factors and medical devices In: Shojania K, Duncan B, McDonald K, Wachter R, eds. Making health care safer: A critical analysis of patient safety practices. AHQR Publication #01-E058, Evidence Report/Technology Assessment, #43, July 20, 2001, pp.463-474

Myerson KR, Ilsley A, Runciman W, An evaluation of ventilator monitoring alarms. Anaesth Intensive Care. 1986;14:174-185

Mylrea KC, Orr JA, Westenskow DR. Integration of monitoring for intelligent alarms in anesthesia: neural networks--can they help? J Clin Monit 1993;9:31-37

Navabi MJ, Watt RC, Hameroff ST, Mylrea KC. Integrated monitoring can detect critical events and improve alarm accuracy. J Clin Eng 1991;16:295-306

Nazir T, Beatty PC. Anaesthetists' attitudes to monitoring instrument design options. Br J Anaesth. 2000;85:781-784

Oberli C, Urzua J, Saez C, Guarini M, Ciprianio A, Garayar B, Lema G, Canessa R,

Sacco C, Irarrazaval M. An expert system for monitor alarm integration. J Clin Monit Comput 1999;5:29-35

O'Carroll TM. Survey of alarms in an intensive therapy unit. Anaesthesia 1986;41:742-744

O'Hara JM, Brown WS, Higgins JC, Stubler WF. Human Factors Engineering Guidance for the Review of Advanced Alarm Systems. NUREG/CR-6105 BNL-NUREG-52391. Upton: NY: Brookhaven National Laboratory. 1994

Ojaniemi J, van Gils M, Korhonen I, Nieminen K. Intelligent Alarms for Efficient Detection of Patient Disorders in the lCU, Med Bio Eng Comp, 1997;35:619 (Supp. Pt 1)

Olympio M, Stoelting R. On the use of audible beep tone from the pulse oximeter and audible physiological alarms, The APOSF Board of Directors Workshop, 10/22/2004.

Orr J, Westenskow D. A breathing circuit alarm system based on neural networks. Anesth 1989;71:A339.

Orr J, Westenskow D. Evaluation of a breathing circuit alarm system based on neural networks. Anesth 1990;73:A445.

Orr J, Simon F, Bender H, et al. Response times with smart alarms. Anesth 1990;73:A447

Orr J, Westenskow D. Evaluation of a breathing circuit alarm system based on neural networks. Anesth 1990;73:A445

Orr J, Westenskow D. A breathing circuit alarm system based on neural networks. J Clin Monit 1994;10:101-109

Pan P, James C. Effects of default alarm limit settings on alarm distribution in telemetric pulse oximetry network I???ward setting. Anesth 1991;75:A405.

Patterson R, Edworthy J, Shailer M, Lower M, Wheeler P. Alarm Sounds for Medical Equipment in Intensive Care Areas and Operating Theatres. Report AC598. Institute of Sound and Vibration Research, Southampton, 1986

Patterson RD. Guidelines for the design of auditory warning sounds. Proceedings of the Institute of Acoustics 1989;11:17-25

Patterson ES, Doebbeling BN, Fung CH, Militello L, Anders S, Asch SM. Identifying barriers to the effective use of clinical reminders: Bootstrapping multiple methods. J Biomed Inform. 2005;38:189-199



Peters A. Audible signaling devices in the medical environment, AAMI 15th Annual Meeting, 1980:164

Philip J. Overview: creating practical alarms for the future, J Clin Monit 1989;5:194-195

Philip J. Thoughtful alarms. In: Gravenstein JS, Newbower RS, Ream AK, et al, eds. The automated anesthesia record and alarm systems. Boston: Butterworth, 1987

Porciello PI. Alarms and coronary care units. G Ital Cardiol 1980;10:939-943

Pownall M. Medical alarms: ringing the changes. Nurs Times 1987;83:18-19

Pryn S, Crosse M. Ventilation disconnexion alarm failures. Anaesthesia 1989;44:978-981

Quinn M. A philosophy of alarms. In: Gravenstein JS, Newbower RS, Ream AK, Smith NT, eds. The automated anesthesia record and alarm systems. Boston: Butterworth.1987:169-173

Quinn M. Semi-practical alarms: a parable. J Clin Monit 1989;5:196-200

Raison J, Beaumont J, Russell J, Osborn J, Gerbode F. Alarms in an intensive care unit: an interim ?? Computers and Biomedical Research 19__:1:556-564

Raphael D, Weller R, Doran D. A response algorithm for the low-pressure alarm condition. Anesth Analg 1985;67:876-883

Raphael D. The low-pressure alarm condition: safety considerations and the anesthesiologist’s response.

Reider B. Red flag or false alarm? Am J Sports Med 2005;33:805

Rheineck-Leyssius AT, Kalkman CJ. Influence of pulse oximeter lower alarm limit on the incidence of hypoxaemia in the recovery room. Br J Anaesth 1997;79:460-464

Rheineck-Leyssius AT, Kalkman CJ. Advanced pulse oximeter signal processing technology compared to simple averaging. II. Effect on frequency of alarms in the postanesthesia care unit. J Clin Anesth 1999;11:196-200

Rheineck-Leyssius AT, Kalkman, CJ. Influence of pulse oximeter settings on the frequency of alarms and detection of hypoxemia. J Clin Monit Comp 1998;14:151-156

Richardson W. Clinical alarm systems testing--a program assessment model. AORN 2004;80:280-288.

Richardson W, Clinical alarm systems testing-a program assessment model.

Ringer S., Fackler J, Icenogle, M, Zimmerman S. Clinical alarms versus statistical quality control.

Rogatko A, Litwin S. Phase II studies: which is worse, false positive or false negative? J Natl Cancer Inst 1996;88:462

Rosenbaum RA, Levine BJ, Sweeney TA. Another false alarm? Apnea monitor activation in a Neonatal Intensive Care Unit Graduate. J Emerg Med 1997;15:855-858

Rung GW, Bennett M. Clinical evaluation of the Monitron™ cardiorespiratory monitor: minimizing false alarms. Anesth 1990:73:A523

Sabar R, Zmora E. Nurse’s response to alarms from monitoring systems in the NICU. Peiatr Res 1997;41:147A

Saeed M, Lieu C, Raber G, Mark RG. MIMIC II: a massive temporal ICU patient database to support research in intelligent patient monitoring. Comput Cardiol. 2002;29:641-644

Samuels I. An alarming problem (Letter to the editor). Anesth 1986;64:128

Sanderson P, Seagull F. Cognitive ergonomics of information technology in critical care; Contexts and modalities for alarm interpretation.

Saranmnmi N, Korhonen I, van Gils M, Kari M. Framework for biosignal interpretation in intensive care and anesthesia. Meth Inf Med 1997;36:340-344

Schaaf C, Block F. Evaluation of alarm sounds in the operating room. J Clin Monit 1989;5:300

Schecke T, Langen M, Rau G. "Intelligent alarms" in the knowledge-based decision support system. AES-2 Helmholtz Institut, Aachen, Germany Research Report 1987/88:172-177

Schecke T, Rau G, Klocke H, Fick M, Kaesmacher H, Hatzky U, Kalff G. Knowledge-based decision support in anesthesia: Toward intelligent alarms and beyond. J Clin Monit 1988;4:159

Schmidt SI, Baysinger CL. Alarms: help or hindrance? Anesth 1986;64:654-655

Schoenberg R, Sands D, Safran C. Making ICU alarms meaningful: a comparison of traditional vs. trend-based algorithms. Proc AMIA Symp 1999;379-383

Schreiber P, Schreiber J. Structured alarms systems for the operating room. J Clinical Monit 1989;5:201-204

Seagull FJ, Sanderson P M. Anesthesia alarms in context. Unpublished manuscript, Swinburne Computer-Human Interaction Laboratory (SCHIL), School of Information Technology, Swinburne University of Technology, Hawthorn, Victoria, Australia. 1997

Seagull FJ, Xiao Y. Patients Monitoring Technology: Friend or Foe? Proceed IEA 2000/HFES 2000 Congress. 2000;4:249

Seagull FJ, Xiao Y, Mackenzie CF, Wickens CD. Auditory alarms: From alerting to informing. Proceed IEA 2000/HFES 2000 Congress. 2000;4:223-226

Seagull FJ, Wickens CD, Loeb RG. Attention and workload in auditory, visual, and redundant patient-monitoring conditions. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2001:1395-1399

Seagull F, Sanderson P, Anesthesia alarm in context: An observational study, Human Factors 2001;43:66-78

Seagull FJ, Sanderson PM. The trojan horse of the operating room: alarms and the noise of anesthesia. In. Bogner S. (Ed). Misadventures in Healthcare: Inside stories. New Jersey: Lawrence Erlbaum. 2004:105-125

Segal B, Retfalvi S, Pavlasek T. "Silent" malfunction of a critical-care device caused by electromagnetic interference. BIT 1995;29:350-354

Sharkey T. Sounding an alarm on alarms. Am J Nurs 1988;88:33

Shelton D. Alarming news for ICUs. Am J Nurs 19??;87:1011-1012

Shirley PJ. Monitoring in anaesthesia and alarm systems. Anaesth Intensive Care. 1997;25:432-433

Simons D, Frederiks T, Tappel J. The evaluation of an auditory alarm for a new medical device. In: Proceed of the human factors and ergonomics Society 41st Annual Meeting, Santa Barbara: Human Factors and Ergonomics Society, 1997:777-781

Sloane E, Gelhot V. Applications of the Petri net to simulate, test, and validate the performance and safety of complex, heterogeneous, multi-modality patient monitoring alarm systems. IEEE/EMBS 26th Annual International Conference. San Francisco, CA Sept 1-4, 2004

Solsona J, Altaba C, Maull E, Rodriguez L, Bosque C, Mulero A. Are auditory warnings in the intensive care unit properly adjusted? J Adv Nurs 2001;35:402-406

Sorkin R. Why are people turning off our alarms? J. Acoustic Soc Amer 1988;84:1107-1108

Spraker T. Alarm strategies for anesthesia: where we’ve been; where we are now; where we’re going. J Clin Monit 1989;5:301

Stanford LM, Mcintyre JWR, Hogan JT. Audible alarm signals for anaesthesia monitoring equipment. Int J Clin Monit Comp 1985;1:251-256

Stanford LM, Mcintyre JWR, Nelson TM Hogan. Affective responses to commercial and experimental alarm signals for anaesthesia delivery and physiological monitoring equipment. Int J Clin Monit Comp 1988;5:111-118

Stanton N. Alarms in a coronary care unit. Contemporary ergonomics: Proceedings of the Ergonomics Society’s 1993 Annual Conference. Edinburgh, Scotland, April 13-16, London: Taylor & Francis 1993

Stanton N. Alarm initiated activities. In: Stanton N, ed: Human factors in alarm design. London: Taylor & Frances. 1994:93-117

Sukuvaara T, Koski E, Makivirta K. A knowledge-based alarm system for monitoring cardiac operated patients--technical construction and evaluation. Int J Clin Monit Comput. 1993;10:117-126

Sury M, Hinds C, Boustred M. Accidental disconnection following inactivation of Serventilator alarm. Anaesthesia 1986;41:91

Sykes M. Panel on practical alarms: Fifth International Symposium of Computing in Anesthesia and Intensive Care: Introduction. J Clin Monit 1989;5:192-193

Tammelleo AD. Failure to use heart monitor alarms: disaster. Regan Rep Nurs Law. 1989;30:1

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Tremper K. False alarms and sensitivity of conventional pulse oximetry versus the Masimo SET technology in the pediatric postanesthesia care unit. Anesth Analg. 2000; 90:1336-1340

Tsien C. Reducing false alarms in the intensive care unit: A systematic comparison of four algorithms.

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van der Aa JJ. Intelligent alarms in anesthesia. Ph.D. Dissertation, Eindhoven Technical University, Netherlands 1990

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Wallace M, Ashman M. Silent page. A vibratory alarm for the hearing impaired anesthesiologist. 2nd Annual Meeting, Soc for Technology in Anesthesia 1992:1-8.1

Wallace M., Ashman M., Matjasko M. Hearing acuity of anesthesiologists and alarm detection. Anesth 1994;81:13-28

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Watt R, Miller K, Navabi M, Hameroff S, Mylrea K. An approach to "smart alarms" in anesthesia monitoring. Anesth 1988;69:A241

Watt R, Navabi M, Mylrea K, Hameroff S. Integrated monitoring "smart alarms" can detect critical events and reduce false alarms. Anesth 1989;71:A338

Watt R, Maslana E, Mylrea K. Alarms and Anesthesia. IEEE/EMBS 1993;12:34-41

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Weinger M. Proposed new alarm standards may make a bad situation worse. Anesthesiologist 1991;74:791-792

Weinger MB, Smith NT. Vigilance, alarms, and integrated monitoring systems In: Ehrenwerth J, Eisenkraft JB. eds. Anesthesia Equipment: Principles and Applications. Malvern, PA: Mosby Year Book 1993:350-384

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Westenskow D, Loeb R, Brunner J, Pace N. Expert alarms and autopilot in an anesthesia workstation. Anesth 1988;69:A731

Westenkow D, Orr J, Simon F, Bender H, Frankenburger H. Intelligent alarms reduce anesthesiologist's response time to critical faults. Anesth 1992;77:1074-1079

Westenkow D. Alarms. In: Saidman L, Smith N Ty. eds. Monitoring in Anesthesia. London: Butterworth-Heinemann 1993:475-490

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Wiklund ME, Hoffman LR. When electronic devices outnumber flower bouquets in the hospital room. Proceed of the Human Factors Society 32nd Annual Meeting. California, Human Factor Society1988:430-434

Wiklund ME, Smith EA. Answering the call for harmonization of medical device alarms 2001 Oct [cited 2002 Oct 24]

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Woods D D. The alarm problem and directed attention in dynamic fault management. Ergonomics 1995;38:2371-2394

Wright B. Apnoea alarms. Br Med J (Clin Res Ed) 1984;289:1536-1537

Xiao Y, Mackenzie CF, Jaberi M, Harper B, and the LOTAS Group. Alarms: Silenced, ignored, and missed. Anesth 1996:73

Xiao Y, Mackenzie CF, Spencer R, Jaberi M, Koch M, and the LOTAS Group. Intrusiveness of auditory alarms during airway management. Anesth 1998;89:A1224

Xiao Y, Seagull F, Wickens C, Mackenzie C. Auditory warning signals in critical care settings, NPSF Research Awards, 1998

Xiao Y, Seagull FJ. An analysis of problems with auditory alarms: defining the roles of alarms in process monitoring tasks. Proceedings of Human Factors and Ergonomics 43rd Annual Meeting. 1999:256-260

Xiao Y, Mackenzie CF, Seagull FJ, Jaberi M. Managing the Monitors: An Analysis of Alarm Silencing Activities During An Anesthetic Procedure. Proceed of IEA 2000/HFES 2000 Congress 2000;4:250-253

Xiao Y, Seagull F. Auditory Warning Signals: New Concepts and Approaches. Proceedings of IEA 2000/HFES 2000 Congress. 2000;4:210

Xiao Y, Seagull F, Nieves-Khouw F, Barczak N, Perkins S. Organizational-historical analysis of the "failure to respond to alarm" problems. IEEE Transaction on systems man and cybernetics-part A: Systems and Humans, 2004:34

Yuki Y. Alarm system optimization for increasing operations productivity. ISA Trans 2002;41:383-387

Xiao Y, Seagull FJ. Toward a user friendly health care environment: The case of alarms. Forum (Risk Management Foundation, Harvard Medical Institutions), 2001;21:17-18

Zbinden AM, Hutmacher M. More on standardized alarms. Anesth 1991; 75:1125

Zotter H, Schenkeli R, Kurz R, Kerbl R. Short-term event recording as a measure to rule out false alarms and to shorten the duration of home monitoring in infants. Wien Klin Wochenschr 2003;31:53-57

Alarm Standards, Guidelines and Papers

IEC 60601-1-8. General requirements, tests and guidance for alarms in medical electrical equipment and medical systems, (Draft-11/7/2002). International Electrotechnical Commission, Geneva, Switzerland.

ASTM F1463-93 (Reapproved 1999). Standard specifications for alarm signals in medical equipment used in anaesthesia and respiratory care (Subcommittee F29.03.04-Harmonization of Alarms draft). American Society for Testing and Materials, Philadelphia, PA

ISO 7731. Danger Signals.for Workplaces: Auditory Danger Signals, 1986. International Organization for Standardization, Geneva

ISO 1987. Specification for alarm signals used in anaesthesia and critical care (ISO/TC 121/SC 3 N687), International Organization for Standardization, Helsinki

JCAHO. Preventing ventilator-related deaths and injuries. Sentinel Event Alert 2002;26: 1-3

JCAHO. Clinical alarms goal remains intact.... Joint Commission expands 2004 goals.

BIT 2003;37:307

HE-48:1993. Human factors engineering guidelines and preferred practices for the design of medical devices. AAMI Guideline. Association for the Advancement of Medical Instrumentation Arlington, VA

HE74:2001. Human factors design process for medical devices. ANSI/AAMI Standard. Association for the Advancement of Medical Instrumentation Arlington, VA

Olympio M. APSF workshop recommends new standard. APSF workshop, Las Vegas, October 22, 2004

Welyczko G, Graber M. International standards for visual and auditory alarm signals for medical devices. BIT 1994:228-231

Wiklund M, Gardner-Bonneau D, Carstensen P, Weinger M. Global standardization of human factors for medical devices and systems. In: Proceedings of the Human Factors and Ergonomics Society 44th Annual Meeting, Santa Barbara, CA: Human Factors and Eronomics Society. 2000:533-36

Williams JS. Meeting the challenge: how hospitals complied with the new clinical alarms requirement. Biomed Inst Technol. 2003;37:319-328

Noise in Acute Care As Related to Alarms.

Amenedo E, Escera C. The accuracy of sound duration representation in the human brain determines the accuracy of behavioural perception. Eur J Neurosci. 2000;12:2570-2574

Baker C. Sensory overload and noise in the ICU; Sources of environmental stress. Crit Care Q 1984;6:66-80

Balogh D, Kittinger E, Benzer A, Hackl J. Noise in the ICU. Inten Care Med 1993;19:343-346

Bentley S, Murphy F, Dudley H. Perceived noise in surgical wards and an intensive care area: an objective analysis. Br Med J 1977;10:1503-1506

Berlyne D, McDonnell P, Nicki R, Parham L. Effects of auditory pitch and complexity of EEG desynchronization and on verbally expressed judgments. Can J Psychology 1967;21:346-367

Bricker P. Listener evaluation of simulated telephone calling signals, The Bell System Technical Journal. 1971;50:1559-1578

Burt JL, Bartolome DS, Burdette DW, Comstock JR Jr. A psychophysiological evaluation of the perceived urgency of auditory warning signals. Ergonomics 1995; 38:2327-2340

De Boer E. On the 'residue' and auditory pitch perception. In: Keidel WD, Neff WD eds. Handbook of Sensory Physiology Vol. 5: Auditory System. Part 3: Clinical and Special Topics, New York: Springer-Verlag 1976:479-583

Edworthy J, Hellier E. Auditory warnings in noisy environments. Noise Health. 2000;2:27-40

Edworthy J. The design and implementation of non-verbal auditory warnings. Appl Ergon 1994;25:202-210

Fife D, Rappaport E. Noise and hospital stay. Am J Pub Health 1976;66:680-681

Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, Hanly PJ. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 2003;167:708-715

Gast P, Baher C. The CCU patient: anxiety and ?ance to noise. Crit Care Nurs Q 1989;12:39-54

Guilford J. System in the relationship of affective value to frequency and intensity of auditory stimuli, American Journal of Psychology. 1954;67:691-695

Hansell HN. The behavioral effects of noise on man: the patient with "intensive care unit psychosis". Heart Lung 1984;13:59-65

Hartmann W. Localization of sound in rooms. J Acoust Soc Amer 1983;74:1380-1391

Hodges B, Thompson J. Noise pollution in the operating theatre. Lancet 1990;335:891-894

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Kahn DM, Cook TE, Carlisle CC, Nelson DL, Kramer NR, Millman RP. Identification and modification of environmental noise in an ICU setting. Chest 1998;114:535-540

Kam PC, Kam AC, Thompson JF. Noise pollution in the anaesthetic and intensive care environment. Anaesthesia 1994;49:982-986

Liu EH, Tan S. Patients' perception of sound levels in the surgical suite. J Clin Anesth. 2000;12:298-302

Meyer-Falcke A, Rack R, Eichwede F, Jansing PJ. How noisy are anaesthesia and intensive care medicine? Quantification of the patients' stress. Eur J Anaesthesiol 1994; 11:407-411

Mills AW. Auditory localization. In: Tobias JV. ed. Foundations of Modern Auditory Theory. Vol. II. New York: Academic, 1972:303-348

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Moore MM, Nguyen D, Nolan SP, Robinson SP, Ryals B, Imbrie JZ, Spotnitz W. Interventions to reduce decibel levels on patient care units. Am Surg 1998;64:894-899

Morrison WE, Haas EC, Shaffner DH, Garrett ES, Fackler JC. Noise, stress, and annoyance in a pediatric intensive care unit. Crit Care Med 2003;31:113-119

Oei A, Hartley LR. The effects of caffeine and expectancy on attention and memory. Hum Psychopharmacol 2005;20:193-202

Patterson RD. Guidelines for Auditory Warning Systems of Civil Aircraft. CAA paper 82017. Civil Aviation Authority, London. 1982

Patterson RD. Auditory warning systems for high workload environment. Ergonomics International 1985;85:163-165

Patterson RD. Guidelines for the design of auditory warning sounds. In: Lawrence R. ed. Acoustics '89: Proceedings of The Institute of Acoustics. Vol. II, Part 5 (The Institute of Acoustics, Edinburgh) 1989: 7-24

Patterson RD. Auditory warning sounds in the work environment. Philosophical Transactions of the Royal Society of London 1990;327;485-492

Patterson RD, Milroy R. Auditory Warnings on Civil Aircraft: The Learning and Retention of Warnings (CAA Paper 7D/S/0142). Civil Aviation Authority, London. 1980

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Scharf B, Quigley S, Aokl C, Peachey N, Reeves A. Focused auditory attention and frequency selectivity. Perception & Psychophysics 1987;42:215-223

Schulte GT, Block FE Jr. Can people hear the pitch change on a variable-pitch pulse oximeter: Anesth 1989;70:A340

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Sorkin R, D. Design of auditory and tactile displays. In: Salvendy G. ed. Handbook of Human Factors. New York: Wiley. 1987

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Topf M, Dillon E. Noise-induced stress as a predictor of burnout in critical care nurses. Heart Lung 1988;17:567-554

Topf M. Noise-induced occupational stress and health in critical care nursing. Hosp Topics 1988;66:30-40

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Turner A., King C, Craddock J. Measuring and noise. Hospitals 1975;49;85-90

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Woods NF, Falk SA. Noise stimuli in the acute care area. Nurs Res 1974; 23:144-150

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General Articles Related to Alarms

___, 3rd International symposium on Advanced Physiological Monitoring. Munich, Germany, September 8-10, 1994. Abstracts. Clin Intensive Care. 1994;5:1-54

Alcover IA, Henning RJ, Jackson DL. A computer-assisted monitoring system for arrhythmia detection in a medical intensive care unit. Crit Care Med 1984;12:888-891

Amsler BE, Becker LC, Bulkley BH. Performance of a computerized CCU arrhythmia monitor system. J Clin Eng 1982;7:201-209

Arnson LA, Rau JL Jr, Dixon RJ. Evaluation of two electronic respiratory rate monitoring systems. Respir Care 1981;26:221-227

Bergbom-Engberg I, Haljamae H. Assessment of patient experience of discomforts during respiratory therapy. Crit Care Med 1989;17:1068-1072

Blum LR. Equipment design and human limitations. Anesth 1971;35:101-102

Bowton DL, Scuderi PE, Harris L, et al. Pulse oximetry monitoring outside the intensive care unit: Progress or Problem? Ann Intern Med 1991;115:450-454

Burt J, Bartolome D, Burdette D, Comstock J. A psychophysiological evaluation of the perceived urgency of auditory warning signals. Ergonomics 1995;38:2327-2340

Cass NM, Crosby WM, Holland RB. Minimal monitoring standards. Anaes Intens Care 1988;16:110-113

Davis DM. Analysis of anaesthetic mishaps. Int Anaes Clin 1989;22:31-42

Donchin Y, Seagull FJ. The hostile environment of the intensive care unit. Curr Opin Crit Care 2002;8:316-320

Dresselhaus TR, Luck J, Peabody JW. The ethical problem of false positives: a prospective evaluation of physician reporting in the medical record. J Med Ethics 2002; 28:291-294

Duberman SM, Bendixen HH. Concepts of fail safe in anaesthetic practice. Int Anes Clin 1984;22:149-165

Eichorn JH, Cooper JB, Cullen DJ, et a1. Standards for patient monitoring during anesthesia at Harvard Medical School. JAMA 1986;256:1017-1020

Folke M, Cernerud L, Ekstrom M, Hok B. Critical review of non-invasive respiratory monitoring in medical care. Med Biol Eng Comput 2003; 41:377-383

Frey B, et al. Comprehensive critical incident monitoring in a neonatal-pediatric intensive care unit: Experience with the systems approach. Inten Care Med 2000; 26:69-74

Hay WW, Rodden DJ, Collins SM, Melara DL, Hale KA, Fashaw LM. Reliability of conventional and new pulse oximetry in neonatal patients. J Perin 2002;22:360-366

Gaba D, Lee T. Measuring the workload of the anaesthesiologist. Anesth Analg 1990;71:354-361

Gibbons C, Geller S, Glatz E. Biomedical equipment in the neonatal intensive care unit: is it a stressor? J Perinat Neonatal Nurs 1998;12:67-73

Gordh T, Rawal N, Strom S, Hok B. Respiratory monitoring during postoperative analgesia. J Clin Monit 1995;11:365-372

Hayashi S. Significance and problems associated with introduction of high technology in medicine. Kango Tenbo 1982;7:1057-1061

Hamilton WK. Do we monitor enough? We monitor too much. J Clin Monit 1986;2:264-266

Hope C, Morrison D. Understanding and selecting monitoring equipment in anaesthesia and intensive care. Canadian Anaesthetists Society Journal 1986;33:670-679

Hripcsak G. Monitoring the monitor: automated statistical tracking of a clinical event monitor. Comput Biomed Res 1993;26:449-466

Jopling MW, Mannheimer PD, Bebout DE. Sensitivity and specificity performance during motion artifact in three pulse oximeters designed for use in motion. Anesth 93(3A) 2000:A585

Kawagishi T, Kanaya N, Nakayama M, Kurosawa S, Namiki A. A comparison of the failure times of pulse oximeters during blood pressure cuff-induced hypoperfusion in volunteers. Anesth Analg 2004;99:793-796

Lee T, Goldman L. The coronary care unit turns 25: historical trends and future directions. Ann Intern Med 1988;108:887-894

Leung YK, Smith S, Parker S, Martin R. Learning and Retention of Auditory Warnings. 2001

Loeb R. A measure of intraoperative attention to monitors displays. Anesth Analg. 1993;76:337-341

McCarthy E. The Impact of New Technology on Patients and Workers in the Health Service, Ireland. European Foundation for The Improvement of living and Working Conditions. Dublin: Government Publications. 1985

Mora F, Passariello G, Carrault G, Le Pichon J. Intelligent Patient Monitoring and Management Systems: A review. IEEE EMB Mag. 1993;12:23-33

Noblet T. Patient safety and staff satisfaction following conversion to Masimo Set pulse oximetry: experience in the neonatoal ICU. Respiratory Care 2001;46:1140

O'Hara JF Jr, Higgins TL. Total electrical power failure in a cardiothoracic intensive care unit. Crit Care Med 1992;20:840-845

Okuaki A. Present status and problems of monitoring in ICU. Masui 1988;37:776-785

Pelczarski K. Continuum of care monitoring - its time has come. ECRI/American Association of Critical-Care Nurses (AACN). AACN Product No. 1105. Jan 1998

Rampil IJ. Intelligent detection of artifact. In: Gravenstein JS, Newbower RS, Ream AK, Smith NT, eds: The automated anesthesia record and alarm systems. Boston: Butterworth. 1987:175-190

Ronnback BI, Nordberg ML, Olsson A, Ostman A. Evaluation of environmental monitoring strategies. Ambio 2003;32:495-501

Sara C, Wark H. Disconnection: an appraisal, Anesthesia and Intensive Care. 1986;14:448-452

Schreiber P, Schreiber J. Anesthesia System Analysis and Risk Reduction. Safety Guidelines. North American Drager. Boston: Merchant Press. 1987

Singer W, Young P. Studies in affective reaction: II: dependence of affective ratings upon the stimulus-situation, Journal of General Psychology 1941;24:302-325

Tsien C, Fackler JC. Poor prognosis for existing monitors in the intensive care unit. Crit Care Med 1997;25:614-619