title: Automated alerting and recommendations for the management of patients with preexisting hypoxia and potential acute lung injury: a pilot study.
abstract: BACKGROUND
  Acute lung injury (ALI) is associated with high mortality. Low tidal volume (Vt) ventilation has been shown to reduce mortality in ALI patients in the intensive care unit. Anesthesiologists do not routinely provide lung-protective ventilation strategies to patients with ALI in the operating room. The authors hypothesized that an alert, recommending lung-protective ventilation regarding patients with potential ALI, would result in lower Vt administration.
  
  
  METHODS
  The authors conducted a randomized controlled trial on anesthesia providers caring for patients with potential ALI. Patients with an average or last collected ratio of partial pressure of arterial oxygen to inspired fraction of oxygen less than 300 were randomized to providers being sent an alert with a recommended Vt of 6 cc/kg predicted body weight or conventional care. Primary outcomes were Vt/kg predicted body weight administered to patients. Secondary outcomes included ventilator parameters, length of postoperative ventilation, and death.
  
  
  RESULTS
  The primary outcome was a clinically significant reduction in mean Vt from 508-458 cc (P = 0.033), with a reduction in Vt when measured in cc/kg predicted body weight from 8 to 7.2 cc/kg predicted body weight (P = 0.040). There were no statistically significant changes in other outcomes or adverse events associated with either arm.
  
  
  CONCLUSIONS
  Automated alerts generated for patients at risk of having ALI resulted in a statistically significant reduction in Vt administered when compared with a control group. Further research is required to determine whether a reduction in Vt results in decreased mortality and/or postoperative duration of mechanical ventilation.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan 48109-5861, USA. jmblum@umich.edu
authors.forename: James M
authors.initials: JM
authors.lastname: Blum
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stentz
authors.forename: Michael D
authors.initials: MD
authors.lastname: Maile
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jewell
authors.forename: Krishnan
authors.initials: K
authors.lastname: Raghavendran
authors.forename: Milo
authors.initials: M
authors.lastname: Engoren
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
mesh_terms: D055371:Acute Lung Injury / Q000150:complications / Q000628:therapy*; D000328:Adult; D000368:Aged; D005260:Female; D063025:Health Information Management / Q000379:methods*; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000628:therapy*; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D013990:Tidal Volume