title: Effectiveness of an Electronic Alert for Hypotension and Low Bispectral Index on 90-day Postoperative Mortality: A Prospective, Randomized Trial.
abstract: We tested the hypothesis that an electronic alert for a "double low" of mean arterial pressure less than 75 mmHg and a bispectral index less than 45 reduces the primary outcome of 90-day mortality.
  
  
  
  Adults having noncardiac surgery were randomized to receive either intraoperative alerts for double-low events or no alerts. Anesthesiologists were not blinded and not required to alter care based upon the alerts. The primary outcome was all-cause 90-day mortality.
  
  
  
  Patients (20,239) were randomized over 33 months, and 19,092 were analyzed. After adjusting for age, comorbidities, and perioperative factors, patients with more than 60 min of cumulative double-low time were twice as likely to die (hazard ratio, 1.99; 95% CI, 1.2 to 3.2; P = 0.005). The median number of double-low minutes (quartiles) was only slightly lower in the alert arm: 10 (2 to 30) versus 12 (2 to 34) min. Ninety-day mortality was 135 (1.4%) in the alert arm and 123 (1.3%) in the control arm. The difference in percent mortality was 0.18% (99% CI, -0.25 to 0.61).
  
  
  
  Ninety-day mortality was not significantly lower in patients cared for by anesthesiologists who received automated alerts to double-low states. Prolonged cumulative double-low conditions were strongly associated with mortality.
authors: Departments of Anesthesiology (P.J.M., M.A.L., D.L.R.), Genetics and Genomic Sciences (M.A.L.), and Population Health Science and Policy (H.-M.L.), Icahn School of Medicine at Mount Sinai, New York, New York; and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.).
authors: Patrick J
authors: PJ
authors: McCormick
authors: Matthew A
authors: MA
authors: Levin
authors: Hung-Mo
authors: HM
authors: Lin
authors: Daniel I
authors: DI
authors: Sessler
authors: David L
authors: DL
authors: Reich
mesh_terms: D000328:Adult; D056902:Clinical Alarms / Q000706:statistics & numerical data*; D056805:Consciousness Monitors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies