Guidelines for the acute care of severe limb trauma patients
Anaesth. Crit. Care Pain Med
; 40(4)20210528.
Artigo
em Inglês
| BIGG - guias GRADE
| ID: biblio-1292462
Biblioteca responsável:
BR1.1
ABSTRACT
To provide healthcare professionals with comprehensive multidisciplinary expert recommendations for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. The committee addressed eleven questions relevant to the patient suffering severe limb trauma 1) What are the key findings derived from medical history and clinical examination which lead to the patient's prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. The experts' synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/-) and 12 had a low level of evidence (GRADE 2+/-). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. There was significant agreement among experts on strong recommendations to improve practices for severe limb trauma patients.
Texto completo:
Disponível
Coleções:
Bases de dados temática
Contexto em Saúde:
Agenda de Saúde Sustentável para as Américas
/
ODS3 - Saúde e Bem-Estar
Problema de saúde:
Objetivo 9: Redução de doenças não transmissíveis
/
Meta 3.4: Reduzir as mortes prematuras devido doenças não transmissíveis
Base de dados:
BIGG - guias GRADE
Assunto principal:
Síndromes Compartimentais
/
Extremidades
Tipo de estudo:
Guia de prática clínica
Idioma:
Inglês
Revista:
Anaesth. Crit. Care Pain Med
Ano de publicação:
2021
Tipo de documento:
Artigo
Instituição/País de afiliação:
CHU Lille/FR
/
CHU Montpellier/FR
/
CHU de Bordeaux/FR
/
Hôpital d'Instruction des Armées Legouest/FR
/
Hôpital d'Instruction des Armées Sainte Anne/FR
/
Hôpitaux Universitaire de Strasbourg/FR
/
Hôpitaux Universitaires de Strasbourg/FR
/
Université Grenoble Alpes/FR
/
Université de Paris/FR