“Triple Low”

Kheterpal, Sachin; Avidan, Michael S.

doi:10.1097/aln.0b013e31825681e7

Cited by 24 publications

(3 citation statements)

References 13 publications

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“…This approach is reasonable because intraoperative events, such as hypothermia and hypotension, are associated with adverse outcomes and are therefore a potential target for improved care. 40 We did not track different postoperative care interventions that could have impacted subsequent short-term mortality.…”

Section: Discussionmentioning

confidence: 99%

Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients

Palmer

Taitsman

Reed

et al. 2018

Geriatr Orthop Surg Rehabil

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Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), intraoperative hypotension (IOH), and a geriatric medicine consult index (GCI) with short-term mortality in hip fracture patients. A retrospective cohort study was conducted at a single institution over a 2-year period. Patients aged 65 years and older who sustained a hip fracture following a low-energy mechanism were identified using billing records and our orthopedic fracture registry. Medical records were reviewed to collect demographic data, fracture classification and operative records, calculation of CCS, intraoperative details including hypotension, and assessments recorded in the geriatric consult notes. The GCI was calculated using 30 dichotomous variables contained within the geriatric consult note. The index, ranging from 0 to 1, included markers for physical and cognitive function, as well as medications. A higher GCI score indicated more markers for frailty. One hundred eight patients met inclusion criteria. Sixty-four (59%) were females and the average age was 77.3 years. Thirty-five (32%) patients sustained femoral neck fractures, and 73 (68%) patients sustained inter-/pertrochanteric hip fractures. The 30-day mortality was 6%; the 90-day mortality was 13%. The mean GCI was 0.30 in the 30-day survivor group as compared to 0.52 in those who died. The mean GCI was 0.28 in patients who were alive at 90 days as compared to 0.46 in those who died. In contrast, the CCS and IOH were not associated with 30- or 90-day mortality. In our older hip fracture patients, an index calculated from information routinely obtained in the geriatric consult evaluation was associated with 30- and 90-day mortality, whereas the CCS and measures of IOH were not.

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Section: Discussionmentioning

confidence: 99%

Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients

Palmer

Taitsman

Reed

et al. 2018

Geriatr Orthop Surg Rehabil

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“…Auch eine retrospektive Analyse von 24.000 Allgemeinanästhesien wies einen Zusammenhang zwischen dem „Triple-low“-Zustand (Kombination aus niedrigem MAC < 0,8, niedrigem BIS < 45 und niedrigem mittleren Blutdruck < 75 mm Hg) und der postoperativen 30-Tage Mortalität nach [ 40 ]. Das entsprechende Editorial „Murderer, mediator, or mirror“ stellt aber die Kausalität gekonnt infrage [ 41 ]. Auch eine randomisierte kontrollierte Studie mit 6600 Patienten konnte keinen Vorteil hinsichtlich der Einjahresmortalität bei Patienten nachweisen, bei denen während der Operation ein BIS-Index von 35 bzw.…”

Section: Spezifische Technische Und Evidenzbasierte Unterschiede Proz...unclassified

Processed EEG for personalized dosing of anesthetics during general anesthesia

et al. 2023

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ZusammenfassungDie Elektroenzephalogramm(EEG)-gesteuerte Anästhesie ist aus modernen Operationssälen nicht mehr wegzudenken und hat sich als Standard-Monitoring etabliert. Viele Anästhesisten verlassen sich dabei auf die prozessierten EEG-Indizes und hoffen, dadurch ihren Patienten anästhesiebedingte Komplikationen wie intraoperative Awareness, postoperatives Delir oder andere kognitive Komplikationen zu ersparen. Diese Übersichtsarbeit fasst klinisch relevante Informationen und Studien über die 5 im Klinikalltag am häufigsten verwendeten Anästhesietiefe-Monitore zusammen. Messprinzipien, die den verschiedenen Monitoren zugrunde liegen, werden erläutert. Zudem wird eine praktische Anleitung im Umgang mit potenziellen Artefakten und irreführenden „Trendanzeigen“ im prozessiertem EEG angeboten.

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“…The anesthetic “triple-low” case has quite clearly illustrated these difficulties : Sessler et al [ 9 ] analysed a massive retrospective monocentric dataset of 24,120 patients undergoing general anesthesia for non-cardiac surgery and reported a statistically significant association between triple low (low bispectral index, low mean arterial pressure and low minimum alveolar concentration fraction) cumulative time and postoperative mortality. An editorial accompanying the publication commented that a “triple low may simply reflect the patient’s underlying disease”, that if the relation was causal, the physiopathology leading to the all-cause mortality increase was unclear and that future research should be dedicated to reproducing or refuting the findings [ 10 ]. Kertai et al analysed a dataset of similar patients retrospectively (mono-center, 16,263 cases) but found no statistical association between the so-called triple low cumulative time and perioperative or intermediate-term mortality [ 11 ].…”

mentioning

confidence: 99%

When nociception monitoring becomes predictive of surgical outcomes : has the future already become real ?

Jeanne

2024

J Clin Monit Comput

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“Triple Low”

Cited by 24 publications

References 13 publications

Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients

Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients

Processed EEG for personalized dosing of anesthetics during general anesthesia

When nociception monitoring becomes predictive of surgical outcomes : has the future already become real ?

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