J Clin Monit Comput - Use of a decision support system improves the management of hemodynamic and respiratory events in orthopedic patients under propofol sedation and spinal analgesia: a randomized trial.


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Decision support systems (DSSs) have been successfully implemented into clinical practice offering clinical suggestions and treatment options with excellent results in various clinical settings. Although their results appeared promising, showing that DSSs can increase anesthesiologists' vigilance and patient safety during surgery, DSSs have never been used before to help anesthesiologists in identifying critical events in patients under spinal analgesia with sedation. We have developed and clinically evaluated a DSS for this specific task. The DSS was developed with the ability to indicate respiratory and hemodynamic critical events via audio-visual alarms and give decisional aid. Critical respiratory events were defined as SpO2 <92 % and/or respiratory rate <8/min. Critical hemodynamic events were defined as mean arterial pressure (MAP) <60 mmHg and/or heart rate <40 bpm. The objective of this trial was to determine the duration to detect and treat these critical events with the help of the DSS (DSS Group) compared with a standard Control Group where the system was not in place. One hundred and fifty orthopedic patients undergoing spinal analgesia with propofol sedation were enrolled in this randomized control trial, 75 each group. All respiratory and hemodynamic critical events were detected in the DSS Group, while in the Control Group 26 % of the events were not detected.The delay to detect and treat critical events was significantly shorter (P < 0.0001) in the DSS Group at 9.1 ? 3.6 s, whereas 27.5 ? 18.9 s were necessary to identify them in the Control Group. There were no significant differences in physiological parameters in the two groups during surgery. The number of critical events/h occurring and the duration of surgery were similar in both groups. The number of hypoxemia episodes was significantly less (P = 0.036) in the DSS group (0.7 ? 1.0 vs. 1.4 ? 2.2 for the Control Group). The DSS tested in this trial could help the clinician to detect and treat critical events more efficiently and in a shorter length of time.

Resumo Limpo

decis support system dsss success implement clinic practic offer clinic suggest treatment option excel result various clinic set although result appear promis show dsss can increas anesthesiologist vigil patient safeti surgeri dsss never use help anesthesiologist identifi critic event patient spinal analgesia sedat develop clinic evalu dss specif task dss develop abil indic respiratori hemodynam critic event via audiovisu alarm give decision aid critic respiratori event defin spo andor respiratori rate min critic hemodynam event defin mean arteri pressur map mmhg andor heart rate bpm object trial determin durat detect treat critic event help dss dss group compar standard control group system place one hundr fifti orthoped patient undergo spinal analgesia propofol sedat enrol random control trial group respiratori hemodynam critic event detect dss group control group event detectedth delay detect treat critic event signific shorter p dss group s wherea s necessari identifi control group signific differ physiolog paramet two group surgeri number critic eventsh occur durat surgeri similar group number hypoxemia episod signific less p dss group vs control group dss test trial help clinician detect treat critic event effici shorter length time

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