Что нового в неотложной медицине [UpToDate]:
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: May 2018. | This topic last updated: Jun 29, 2018.
The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.
ADULT RESUSCITATION
Hyperosmolar fluids for resuscitation of patients with severe burns (March 2018)
In large total body surface area (TBSA) burns, fluid resuscitation volumes can exceed those predicted by the Parkland formula and lead to complications. Infusion of hyperosmotic fluids may decrease this risk. In a meta-analysis comparing hyperosmotic fluids with isosmotic fluids for fluid resuscitation of patients with severe burns, use of hyperosmotic fluids reduced mean fluid load (volume [mL]/percent TBSA/weight [kg]) 24 hours following burn injury, without altering renal function or mortality [1]. The hyperosmotic fluids included hypertonic saline alone or lactated Ringer's solution plus albumin, fresh frozen plasma, or hydroxyethyl starch. Additional trials are needed to determine whether any of the hyperosmotic fluids result in better outcomes than the others(See "Treatment of deep burns", section on 'Ongoing fluid therapy' and "Emergency care of moderate and severe thermal burns in adults", section on 'Fluid resuscitation'.).
Bag-mask ventilation versus endotracheal intubation for out-of-hospital cardiac arrest (March 2018)
The optimal approach to airway management for sudden cardiac arrest in the pre-hospital setting is uncertain. Although observational data had suggested a survival benefit of bag-mask ventilation over advanced airway approaches, a recent randomized trial found no difference in the primary outcome (survival with favorable neurologic outcome at 28 days) with bag-mask ventilation versus endotracheal intubation [2]. However, trial design issues raise questions about the validity and generalizability of these results. Bag-mask ventilation remains our preferred pre-hospital approach to airway management for cardiac arrest patients. (See "Advanced cardiac life support (ACLS) in adults", section on 'Airway management while performing ACLS'.)
Balanced crystalloids versus isotonic saline in critically ill and noncritically ill patients (March 2018)
The administration of balanced crystalloids (eg, Plasma-Lyte or Ringer's lactate) versus isotonic saline for large volume resuscitation is controversial, hampered by conflicting data and the lack of an ideal crystalloid solution. One randomized trial in over 15,000 critically ill patients [3] and another in over 13,000 noncritically ill patients in the emergency department [4] found that, compared with isotonic saline, balanced crystalloids reduced the composite outcome of death from any cause at 30 days, new renal replacement therapy, or persistent renal dysfunction. Patients who received larger volumes (eg, >2 liters) benefited the most. Because the median volumes of fluid administered in these trials were low (1 liter) and the absolute improvement in the composite response was modest (1 percentage point difference), we suggest choosing the solution based on patient-specific factors such as chemistries, estimated volume of resuscitation, and potential adverse effect of the infused solution. (See "Treatment of hypovolemia or hypovolemic shock in adults", section on 'Buffered crystalloid versus isotonic saline'.)
Correlation of capnography with return of spontaneous circulation in adults with cardiac arrest (January 2018)
In a systematic review of 17 observational studies in over 6100 adults with cardiac arrest, including meta-analyses of data from five studies, end-tidal CO2 (EtCO2) levels ≥10 to 20 mmHg during cardiopulmonary resuscitation (CPR) was strongly associated with the return of spontaneous circulation (ROSC), while a persistent EtCO2 below 10 mmHg after 20 minutes of CPR predicted a 0.5 percent likelih
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: May 2018. | This topic last updated: Jun 29, 2018.
The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.
ADULT RESUSCITATION
Hyperosmolar fluids for resuscitation of patients with severe burns (March 2018)
In large total body surface area (TBSA) burns, fluid resuscitation volumes can exceed those predicted by the Parkland formula and lead to complications. Infusion of hyperosmotic fluids may decrease this risk. In a meta-analysis comparing hyperosmotic fluids with isosmotic fluids for fluid resuscitation of patients with severe burns, use of hyperosmotic fluids reduced mean fluid load (volume [mL]/percent TBSA/weight [kg]) 24 hours following burn injury, without altering renal function or mortality [1]. The hyperosmotic fluids included hypertonic saline alone or lactated Ringer's solution plus albumin, fresh frozen plasma, or hydroxyethyl starch. Additional trials are needed to determine whether any of the hyperosmotic fluids result in better outcomes than the others(See "Treatment of deep burns", section on 'Ongoing fluid therapy' and "Emergency care of moderate and severe thermal burns in adults", section on 'Fluid resuscitation'.).
Bag-mask ventilation versus endotracheal intubation for out-of-hospital cardiac arrest (March 2018)
The optimal approach to airway management for sudden cardiac arrest in the pre-hospital setting is uncertain. Although observational data had suggested a survival benefit of bag-mask ventilation over advanced airway approaches, a recent randomized trial found no difference in the primary outcome (survival with favorable neurologic outcome at 28 days) with bag-mask ventilation versus endotracheal intubation [2]. However, trial design issues raise questions about the validity and generalizability of these results. Bag-mask ventilation remains our preferred pre-hospital approach to airway management for cardiac arrest patients. (See "Advanced cardiac life support (ACLS) in adults", section on 'Airway management while performing ACLS'.)
Balanced crystalloids versus isotonic saline in critically ill and noncritically ill patients (March 2018)
The administration of balanced crystalloids (eg, Plasma-Lyte or Ringer's lactate) versus isotonic saline for large volume resuscitation is controversial, hampered by conflicting data and the lack of an ideal crystalloid solution. One randomized trial in over 15,000 critically ill patients [3] and another in over 13,000 noncritically ill patients in the emergency department [4] found that, compared with isotonic saline, balanced crystalloids reduced the composite outcome of death from any cause at 30 days, new renal replacement therapy, or persistent renal dysfunction. Patients who received larger volumes (eg, >2 liters) benefited the most. Because the median volumes of fluid administered in these trials were low (1 liter) and the absolute improvement in the composite response was modest (1 percentage point difference), we suggest choosing the solution based on patient-specific factors such as chemistries, estimated volume of resuscitation, and potential adverse effect of the infused solution. (See "Treatment of hypovolemia or hypovolemic shock in adults", section on 'Buffered crystalloid versus isotonic saline'.)
Correlation of capnography with return of spontaneous circulation in adults with cardiac arrest (January 2018)
In a systematic review of 17 observational studies in over 6100 adults with cardiac arrest, including meta-analyses of data from five studies, end-tidal CO2 (EtCO2) levels ≥10 to 20 mmHg during cardiopulmonary resuscitation (CPR) was strongly associated with the return of spontaneous circulation (ROSC), while a persistent EtCO2 below 10 mmHg after 20 minutes of CPR predicted a 0.5 percent likelih