在资源有限的环境中,针对严重烧伤患者初始液体管理的适应方法:系统性审查
Kai Hsun Hsiao1, Joseph Kalanzi2, Stuart B Watson3
1Emergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, Switzerland.
Burns open : an international open access journal for burn injuries
|November 14, 2024
概括
有限的证据表明,在大规模伤亡事件 (MCI) 中延迟静脉注射液体复苏可能会增加急性损伤风险. 根据到达时间调整流体计算,省略到达时间.
科学领域:
- 紧急医疗 紧急医疗
- 创伤外科 手术 创伤外科
- 关键的护理关键的护理
背景情况:
- 在大规模伤亡事件 (MCI) 中,资源限制使严重烧伤的液体复苏复杂化.
- 之前的建议建议在MCI中适应常规烧伤护理,包括延迟的静脉注射液体复苏和修改的液体计算公式.
- 这些调整旨在应对在资源限制下提供最佳护理的挑战.
研究的目的:
- 综合和评估有关在资源有限的MCI环境中对重大烧伤的液体复苏适应的证据的确定性.
- 为了评估三个特定的适应:延迟的静脉液体复苏,%TBSA独立的液体计算,以及遗漏的"追赶"液体.
主要方法:
- 在PubMed,EMBASE,CINAHL和Cochrane图书馆进行系统的文献搜索 (搜索时间为2023年9月,更新为2024年7月).
- 包括来自资源有限的环境的初级定量研究,由两名审查员进行评估.
- 用于确定证据确定性的GRADE方法.
主要成果:
- 确定了两项符合条件的研究.
- 非常不确定的证据表明,延迟静脉输液复苏可能会增加急性损伤风险 (或2.48).
- 非常不确定的证据表明,省略"追赶"液体可以保持足够的尿液输出,而不会出现过度/不足复苏的并发症.
结论:
- 有非常有限和不确定的证据支持MCI中烧伤液体复苏的适应.
- 需要进一步的研究,以告知延迟复苏的最佳实践,简化的配方和"追赶"液体缺失.
- 背景因素,当地价值观和可行性是关键考虑因素.
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