The Triple Low …..Another lethal triad

The Trauma lethal triad  the Acidosis ,Hypothermia and Coagulopathy….is not the only triad leads to mortality….in an  interesting paper published this month  in anesthesiology a new Triple low identified that leads to  higher perioperative mortality rates….

The Triple low includes the

Low Blood Pressure

Low BIS index

Low MAC

In this Paper the authors used their institution’s hospital documentation system to evaluate the association between low mean arterial pressure (< 75 mm Hg), low bispectral index (< 45) and low anesthetic concentration (MAC < 0.8) with length of hospital stay and 30-day mortality.

Almost 25,000 patients who underwent noncardiac surgery between January 6, 2005, and December 31, 2009, at the Cleveland Clinic were studied. Bispectral index monitoring was used for all patients, all patients had single volatile agent, and all were at least 16 years old. Those with triple low values stayed longer in the hospital. Thirty-day mortality was also four times higher for those patients with low values for all three variables. In particular, the fraction of patients whose hospital stay was longer than national averages for a particular procedure was seen after cumulative triple low value duration was greater than 30 min. Also, mortality increased when cumulative triple low value duration was 31–45 min and when it was greater than 1 h. The effect on mortality after triple low values was much more apparent than after length of hospital stay.