Bold Voices - December 2017 - 10

AT THE BEDSIDE

Guidelines: Noninvasive Ventilation
for Acute Respiratory Failure
The recommendations should be used in combination
with individual patient factors and clinical judgment.

A

www.aacnboldvoicesonline.org

10

new report summarizes current
knowledge on the role of noninvasive mechanical ventilation
(NIV) in acute respiratory failure (ARF).
"Official ERS/ATS Clinical Practice
Guidelines: Noninvasive Ventilation for
Acute Respiratory Failure," in European
Respiratory Journal, provides evidencebased recommendations from the
European Respiratory Society (ERS)/
American Thoracic Society (ATS) for
the clinical application of NIV based
on current literature. The guideline
committee was "composed of clinicians,
methodologists and experts in the field
of NIV."
"The committee developed recommendations for 11 actionable questions
in a PICO (population-intervention-comparison-outcome) format"
regarding the use of NIV for patients
with ARF. Chronic obstructive pulmo-

nary disease (COPD) exacerbations,
cardiogenic pulmonary edema, first
occurrence of hypoxemic respiratory
failure, immunocompromised patients,
chest trauma, palliation, postoperative care, weaning and postextubation
are the conditions addressed in the
recommendations.
Three "strong" recommendations
with a "high certainty of evidence" are
as follows:
* "Bilevel NIV for patients with
ARF leading to acute or acute-onchronic respiratory acidosis (pH
)7.35) due to COPD exacerbation"
* "A trial of bilevel NIV in patients
considered to require endotracheal intubation and mechanical
ventilation, unless the patient is
immediately deteriorating"

* "Bilevel NIV or CPAP [continuous positive airway pressure] for
patients with ARF" due to cardiogenic pulmonary edema
For the most part, the recommendations are in line with guidelines
published during the last 15 years,
but they include some changes based
on new information. The review
anticipates that "some of these recommendations will change in the future as
new studies are completed, especially
regarding the use of NIV as opposed to
other emerging technologies such as
high-flow nasal cannula therapy and
extracorporeal CO2 removal."
The review notes that the recommendations should be used in
combination with individual patient
factors and clinical judgment.
REFERENCE: Rochwerg B, Brochard L, Elliott MW, et al.
Official ERS/ATS clinical practice guidelines: noninvasive
ventilation for acute respiratory failure. Eur Respir J.
2017;50:1602426.

High-Risk Vascular Surgeries and
Postoperative Myocardial Infarction

F

or patients undergoing high-risk vascular procedures, postoperative myocardial infarction (post-op
MI) has not declined significantly in the past
decade.
"Incidence of Myocardial Infarction After HighRisk Vascular Operations in Adults," in JAMA Surgery,
examines trends in post-op MI. Using data from the
American College of Surgeons National Surgery Quality
Improvement Program, which records preoperative,
operative and 30-day outcome information, the study
involved 90,303 adults who had open aortic surgery or
infrainguinal bypass in U.S. hospitals from 2005 through
2013. The incidence of post-op MI was relatively stable
from 2009 (2.7 percent) to 2014 (3.1 percent).
However, in a related article in MedPage Today, lead
study author Yen-Yi Juo of the University of California,
Los Angeles, and colleagues report that patients undergoing open aortic procedures were more likely to
experience significantly higher incidents of post-op MI,

cardiac arrest and mortality compared to those in the
infrainguinal bypass cohort.
"On the surface the incidence of postoperative
myocardial infarction for either procedure has remained
stable since 2009, but a gradual shift in the patient
population and their implied cardiac risk has occurred,"
the article states. "Patients who underwent open aortic
procedures appeared to have fewer measurable baseline comorbidities but a higher incidence of emergent
procedures, which likely resulted from the availability of
endovascular procedures."
The retrospective cohort study concludes that quality
improvement should focus on post-op MI as the country's
population continues to age. "One specific area of focus
should be why advanced perioperative care did not lead
to reduced cardiac complications," the article adds.
REFERENCE: Juo YY, Mantha A, Ebrahimi R, Ziaeian B, Benharash P. Incidence of
myocardial infarction after high-risk vascular operations in adults [published online
September 6, 2017]. JAMA Surg. doi:10.1001/jamasurg.2017.3360.


http://erj.ersjournals.com/content/50/2/1602426 http://erj.ersjournals.com/content/50/2/1602426 http://erj.ersjournals.com/content/50/2/1602426 http://www.aacnboldvoicesonline.org http://www.jamanetwork.com/journals/jamasurgery/article-abstract/2653287 http://www.jamanetwork.com/journals/jamasurgery/article-abstract/2653287 https://www.medpagetoday.com/Cardiology/MyocardialInfarction/67749?xid=nl_mpt_Weekly_Education_2017-09-13&eun=g5530559d1r

Table of Contents for the Digital Edition of Bold Voices - December 2017

Another Angle
Pres Note Front Teaser
Masthead
AACN Updates Scope and Standards for Acute Care Nurse Practitioners
NTI 2018: Make Your Case for Attending and Register by December
Certification Holiday Reflections
Certified Nurses Day 2018
The Spirit of Giving: One Certified Nurse’s Contributions
Improving Joy in Work
Invest in Yourself With an AACN Scholarship
Disinfectant Use Associated With COPD in Nurses
The Joint Commission Revises NPSG 7 Requirements
Guidelines: Noninvasive Ventilation for Acute Respiratory Failure
High-Risk Vascular Surgeries and Postoperative Myocardial Infarction
FDA Clears MRI System for Premature Babies
New Assay Can Distinguish Bacterial From Viral Infections
Missions of Mercy
How Hospitals Can Save Without Sacrificing Care
DNA Cancer Screening Shows Potential
Smartphone App May Help Screen for Pancreatic Cancer
Cardiologist-Intensivist Model Improves Outcomes
Social Media: Legal and Ethical Issues
Unused Opioids May Pose Health Hazard
AACN’s Facebook Community Weighs In
Conscientious ‘Nudges’ Can Help Patients and Families
Helping ICU Patients With Spiritual Needs
In Our Journals
Transitions
President’s Note
Bold Voices - December 2017 - Cover1
Bold Voices - December 2017 - Cover2
Bold Voices - December 2017 - Pres Note Front Teaser
Bold Voices - December 2017 - Masthead
Bold Voices - December 2017 - NTI 2018: Make Your Case for Attending and Register by December
Bold Voices - December 2017 - Certified Nurses Day 2018
Bold Voices - December 2017 - The Spirit of Giving: One Certified Nurse’s Contributions
Bold Voices - December 2017 - Invest in Yourself With an AACN Scholarship
Bold Voices - December 2017 - The Joint Commission Revises NPSG 7 Requirements
Bold Voices - December 2017 - High-Risk Vascular Surgeries and Postoperative Myocardial Infarction
Bold Voices - December 2017 - New Assay Can Distinguish Bacterial From Viral Infections
Bold Voices - December 2017 - 12
Bold Voices - December 2017 - 13
Bold Voices - December 2017 - How Hospitals Can Save Without Sacrificing Care
Bold Voices - December 2017 - Smartphone App May Help Screen for Pancreatic Cancer
Bold Voices - December 2017 - Social Media: Legal and Ethical Issues
Bold Voices - December 2017 - Unused Opioids May Pose Health Hazard
Bold Voices - December 2017 - 18
Bold Voices - December 2017 - 19
Bold Voices - December 2017 - Transitions
Bold Voices - December 2017 - 21
Bold Voices - December 2017 - President’s Note
Bold Voices - December 2017 - Cover3
Bold Voices - December 2017 - Cover4
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