SCCM发布了关于在患有败血症,ARDS或CAP的急性疾病的成年人中使用皮质类固醇的建议
Rodolfo A Estrada1, Marcos I Restrepo1
1UT Health San Antonio, South Texas Veterans Health Care System, San Antonio, Texas, USA (R.A.E., M.I.R.).
Annals of internal medicine
|May 6, 2024
概括
这一重点更新为在重症监护机构使用皮质类固醇提供了新的指导方针. 它解决了败血症,急性呼吸困难综合征和社区获得的肺炎管理.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- 皮质类固醇经常在重症监护中使用,但它们在特定条件下的最佳使用仍在争论中.
- 自从以前的指导方针以来,证据已经演变,需要更新.
- 败血症,急性呼吸困扰综合征 (ARDS) 和社区获得性肺炎 (CAP) 是常见的情况,其中考虑使用皮质类固醇治疗.
研究的目的:
- 为患者提供针对性更新关于皮质类固醇在败血症,ARDS和CAP患者的使用.
- 综合最近的证据和专家意见,以告知临床实践.
- 为管理这些疾病的临床医生提供明确,可操作的建议.
主要方法:
- 进行了对文献的系统审查.
- 使用GRADE方法评估证据.
- 专家们通过修改的德尔菲过程达成共识.
- 根据综合证据和共识,制定了指导方针.
主要成果:
- 提供了关于在败血症中启动,持续和逐渐减少皮质类固醇的建议.
- 针对ARDS的皮质类固醇使用提供了具体的指导,考虑到不同的病因.
- 详细介绍了皮质类固醇在CAP中的作用,包括严重程度分层.
- 更新澄清了皮质类固醇可能有益,可能有害或具有不确定的效果的情况.
结论:
- 当适当使用时,皮质类固醇治疗可以在患有败血症,ARDS和CAP的特定患者群体中有益.
- 该指南强调了仔细选择患者以及适当的剂量和持续时间的重要性.
- 这些建议旨在优化皮质类固醇的使用,改善患者的治疗结果,并最大限度地减少潜在的不良影响.
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