Triple-low Alerts Do Not Reduce Mortality: A Real-time Randomized Trial.

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Surgical Outcomes

Background:

• Triple-low events, defined by low mean arterial pressure, Bispectral Index, and minimum alveolar fraction, are linked to patient mortality.
• The causal relationship between triple-low events and mortality requires further investigation.

Purpose of the Study:

• To test if real-time alerts for triple-low events reduce 90-day mortality in surgical patients.
• To evaluate the impact of clinical responses to triple-low events on mortality.

Main Methods:

• Adult patients undergoing noncardiac surgery with volatile anesthesia were randomized to receive or not receive triple-low event alerts.
• Helpful responses were defined as vasopressor administration or anesthetic reduction within specified timeframes.

Main Results:

• No significant difference in 90-day mortality was observed between the alert (8.3%) and nonalert (7.3%) groups (HR 1.14; P=0.12).
• Clinical responses occurred in about half of patients in both groups, with no clear association with adjusted 90-day mortality.

Conclusions:

• Real-time alerts for triple-low events did not decrease 90-day mortality.
• The findings suggest no strong relationship between responding to triple-low events and patient mortality.