Automated Alerting and Recommendations for the Management of Patients with Preexisting Hypoxia and Potential Acute Lung Injury: A Pilot Study

James M BLUM; Michael J STENTZ; Michael D MAILE; Elizabeth JEWELL; Krishnan RAGHAVENDRAN; Milo ENGOREN; Jesse M EHRENFELD

doi:10.1097/ALN.0b013e3182987af4

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Automated Alerting and Recommendations for the Management of Patients with Preexisting Hypoxia and Potential Acute Lung Injury: A Pilot Study

Journal article

Open access

Peer reviewed

Automated Alerting and Recommendations for the Management of Patients with Preexisting Hypoxia and Potential Acute Lung Injury: A Pilot Study

James M BLUM, Michael J STENTZ, Michael D MAILE, Elizabeth JEWELL, Krishnan RAGHAVENDRAN, Milo ENGOREN and Jesse M EHRENFELD

Anesthesiology (Philadelphia), Vol.119(2), pp.295-302

2013

DOI: 10.1097/ALN.0b013e3182987af4

PMCID: PMC3813292

PMID: 23681144

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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.

Biological and medical sciences

Anesthesia

Medical sciences

Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy

Details

Title: Subtitle: Automated Alerting and Recommendations for the Management of Patients with Preexisting Hypoxia and Potential Acute Lung Injury: A Pilot Study
Creators: James M BLUM - Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States
Michael J STENTZ - Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States
Michael D MAILE - Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States
Elizabeth JEWELL - Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States
Krishnan RAGHAVENDRAN - Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, United States
Milo ENGOREN - Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States
Jesse M EHRENFELD - Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
Resource Type: Journal article
Publication Details: Anesthesiology (Philadelphia), Vol.119(2), pp.295-302
DOI: 10.1097/ALN.0b013e3182987af4
PMID: 23681144
PMCID: PMC3813292
NLM abbreviation: Anesthesiology
ISSN: 0003-3022
eISSN: 1528-1175
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
Language: English
Date published: 2013
Academic Unit: Anesthesia
Record Identifier: 9984013163602771

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