一项针对极低收缩压补充警报的随机试验。

A Randomized Trial of a Supplemental Alarm for Critically Low Systolic Blood Pressure.

作者信息

Panjasawatwong Krit, Sessler Daniel I, Stapelfeldt Wolf H, Mayers Douglas B, Mascha Edward J, Yang Dongsheng, Kurz Andrea

机构信息

From the Departments of *Outcomes Research, †General Anesthesiology, ‡Regional Anesthesia Practice, Anesthesiology Institute, and §Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.

出版信息

Anesth Analg. 2015 Dec;121(6):1500-7. doi: 10.1213/ANE.0000000000000950.

DOI:10.1213/ANE.0000000000000950

PMID:26465928

Abstract

BACKGROUND

Intraoperative hypotension is associated with complications that might be ameliorated by earlier intervention. We therefore tested the primary hypothesis that a supplemental decision support alert for critically low systolic blood pressure (SBP) decreases the duration of intraoperative hypotension.

METHODS

We enrolled adults having surgery and anesthetized by attending anesthesiologists or nurse anesthetists under attending supervision. When invasive SBP <80 mmHg was detected for 3 consecutive minutes or any oscillometric SBP <80 mmHg, patients were randomly assigned to routine management or a visual alert and pager notification. Clinicians who received alerts were free to act on the alert or not. The primary outcome was time to return to SBP ≥ 80 mmHg. Secondary outcomes were time until SBP remained ≥ 80 mmHg for at least 10 minutes and the duration of hospitalization.

RESULTS

One thousand five hundred ninety-eight patients were randomly assigned to the hypotension alerts and 1567 to no alerts. Randomized groups did not differ on time to return to SBP ≥ 80 mmHg after the first alert, with estimated adjusted hazard ratio of 0.99 (95% confidence interval, 0.92-1.06; P = 0.69). The median time [quartiles] to return to SBP ≥ 80 mmHg was 1 [0, 3] minutes in each group and 1 [0, 3] minutes in the nonalert group (P = 0.69). Hospital length of stay was also similar, with the median [quartiles] lengths of stay being 2 [1, 4] days in the alert group and 2 [1,5] in the nonalert group (P = 0.35).

CONCLUSIONS

An additional warning for severe hypotension did not reduce the duration of hypotension or hospitalization. Decision support alerts may be more useful for more complicated situations.

摘要

背景

术中低血压与一些并发症相关，早期干预或许能改善这些并发症。因此，我们检验了主要假设，即针对严重低血压的补充决策支持警报可缩短术中低血压的持续时间。

方法

我们纳入了接受手术且由主治麻醉医师或在主治医师监督下的麻醉护士进行麻醉的成年人。当连续3分钟检测到有创收缩压（SBP）<80 mmHg或任何示波收缩压<80 mmHg时，患者被随机分配至常规管理组或视觉警报及传呼机通知组。收到警报的临床医生可自行决定是否对警报采取行动。主要结局是收缩压恢复至≥80 mmHg的时间。次要结局是收缩压持续≥80 mmHg至少10分钟的时间以及住院时间。

结果

1598例患者被随机分配至低血压警报组，1567例患者被分配至无警报组。首次警报后收缩压恢复至≥80 mmHg的时间在随机分组的两组间无差异，估计调整后的风险比为0.99（95%置信区间为0.92 - 1.06；P = 0.69）。每组恢复至收缩压≥80 mmHg的中位时间[四分位数间距]均为1[0, 3]分钟，无警报组为1[来源缺失，推测为[0, 3]]分钟（P = 0.69）。住院时间也相似，警报组的中位[四分位数间距]住院时间为2[1, 4]天，无警报组为2[1, 5]天（P = 0.35）。