Clinical Practice Guidelines for the Anesthetic Management of Patients with Pulmonary Hyertension
Other TitlesAnesthetic Management of Pulmonary Hypertension
AbstractProblem: Pulmonary Hypertension (PH) is a severe, progressive, disease with limited treatment options and poor prognosis. The risk of morbidity and mortality increases significantly when patients with PH must undergo surgery. There is a reported 42% increase in morbidity of patients with PH and the rate of perioperative mortality varies between 1-18% for patients undergoing non-cardiac, non-obstetric surgery. A small, academic, secondary care hospital within Maryland has reported an increase in adverse events among patients with PH, including unexpected or prolonged ICU admissions, and respiratory failure. The hospital has identified a need to standardize the care of anesthesia providers in the areas of perioperative management of PH to maximize outcomes and reduce morbidity and mortality. Objective: The purpose of this doctor of nursing practice (DNP) project was to develop and evaluate a clinical practice guideline (CPG) for the intraoperative anesthetic management of PH patients presenting for non-cardiac, non-obstetric surgery. The anticipated outcome of implementation was a reduction in perioperative adverse events such as respiratory failure, heart failure, hemodynamic collapse, abortion of surgical procedure, and unexpected ICU admission. Methods: The project occurred in a three stage format. In the first stage, the most current literature on the intraoperative management of patients with PH was evaluated and a guideline developed using Brower’s Agree II tool. The tool consists of 23 items within 6 quality domains; each domain focuses on a specific feature of a CPG. A team of appraisers critically analyzed and scored the guideline using the Agree II tool. In the second stage, the guideline was evaluated by anesthesia providers using Brower’s practitioner feedback questionnaire (PFQ). This tool seeks and purpose (86%), stakeholder involvement (92%), clarity and presentation (85%), and editorial independence (100%). The lowest scores where in the areas of: rigour of development (80%), and applicability (60%). From the PFQ data agreement or strong agreement was indicated 88% of the time when practitioners were questioned about the need for a guideline, or agreement with the guidelines content. However, the results of the PFQ echoed weaknesses brought to light by the Agree II appraisal. Only 72% of providers agreed that the draft recommendations would make an obvious effect on patient outcomes. Implications: Based on the Agree II and PFQ results, guideline developers decided to incorporate facilitators, barriers, and implications of guideline use into the CPG. The guideline team strongly believes that it is prudent for providers to use the best evidence available to treat patients, and while PH research is limited, the sources that are available should be consulted as a guide for better outcomes. After final review, guideline recommendations were submitted to the anesthesia department as a source of quality improvement. These guidelines are not to be considered generalizable knowledge.
Intraoperative Care--Practice Guideline
Intraoperative Complications--prevention & control
Postoperative Complications--prevention & control
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/6379
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