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Renal Artery Stenting: Coming to a Consensus

Renal Artery Stenting: Coming to a Consensus

Renal artery stenosis (RAS)—narrowing of the renal arteries—is often asymptomatic, but studies show that it may lead to hypertension or worsening of blood pressure (BP) control. If left untreated, RAS can cause kidney failure and heart failure. “Optimal medical therapy is the preferred first-line treatment, but many patients who fail medical therapy may benefit from angioplasty and stenting,” explains Sahil A. Parikh, MD, FACC, FSCAI. “These treatments help to reduce the clinical consequences of RAS.” Studies show that more than 90% of RAS cases result from atherosclerosis, yet there is still debate among experts on the role of medical therapy versus revascularization. Renal artery stenting has emerged as an important primary revascularization strategy in most patients with atherosclerotic RAS. Stenting has become the preferred endovascular technique to manage RAS, with recent studies showing such procedures improve systolic and diastolic BP with excellent safety profiles. However, many of these analyses have non-randomized trial designs, and others excluded some patients who may benefit from renal stenting when randomized trials were conducted. The clinical data have resulted in less widespread acceptance of the benefits of renal artery stenting. New Guidance on Renal Artery Stenting In 2014, the Society for Cardiovascular Angiography and Interventions (SCAI) released a new expert consensus statement for the appropriate use of renal artery stenting. The document, which was based on an expert panel review of scientific data, was developed to help guide physicians in applying renal stenting. SCAI also highlights the current limitations in the peer-reviewed literature and identifies opportunities to advance the field. The consensus statement offers clinicians measures to assess the significance of RAS (Table 1)...
Insights on “Alarm Fatigue”

Insights on “Alarm Fatigue”

The term “alarm fatigue” refers to when clinicians are desensitized by alarms, many of which sound off despite being false or clinically irrelevant. As a result, alarm sounds can become background noise and be perceived by clinicians as part of the normal working environment. Alarms can often be silenced without checking patients or permanently disabled by clinicians who feel the constant messages are bothersome. “Several agencies have warned of deaths due to alarm silencing on patient monitor devices,” says Barbara J. Drew, RN, PhD, FAAN, FAHA. “The FDA and the Joint Commission have also issued alerts about alarm fatigue being a major patient safety concern.” To date, few studies have explored the topic of alarm fatigue to inform clinicians on what to do about this problem. To address this research gap, Dr. Drew and colleagues analyzed data from 461 adults who were treated in five ICUs at the University of California, San Francisco (UCSF) Medical Center over 31 days. The study, published in PLoS One, sought to provide a better understanding of the frequency and accuracy of alarms and false alarm causes of cardiac monitor alarms. Significant Findings on Alarm Fatigue The study showed that more than 2.5 million unique audible and inaudible alarms went off on patients’ monitoring equipment during the 31-day study period. Of this total, more than 1.1 million went off for cardiac arrhythmias, but about 89% of these were false alarms caused by computer algorithm errors. Despite restrictions at UCSF on the number of alarms that generate an audible tone to just those that are considered clinically important, there were more than 381,000 audible alarms....
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