Medicina de Emergências

As diretrizes WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC para diagnóstico e tratamento da diverticulite colônica esquerda aguda em idosos.

25 Jan, 2022 | 11:53h

The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly – World Journal of Emergency Surgery

Conteúdos relacionados:

ACP Guideline: Diagnosis and management of acute left-sided colonic diverticulitis.

Review: Changing paradigms in the management of acute uncomplicated diverticulitis.

RCT: Another study shows that non-antibiotic outpatient treatment in mild acute diverticulitis is safe.

Review: Elective surgical management of diverticulitis

State of the Art Review | Management of colonic diverticulitis

Drains, germs, or steel: Multidisciplinary management of acute colonic diverticulitis

Randomized trial: Laparoscopic lavage vs. primary resection for perforated purulent diverticulitis; similar long-term results, but recurrence was more common after laparoscopic lavage

Randomized trial: In patients with recurrent, complicated, or persistent painful diverticulitis, sigmoid resection improved quality of life but was associated with a small but significant risk of major complications

Systematic review: Management of colonic diverticulitis

WSES Guidelines for the Management of Acute Colonic Diverticulitis

ASCRS Guidelines for the Treatment of Left-Sided Colonic Diverticulitis

---

Diretrizes perioperatórias sobre agentes antiplaquetários e anticoagulantes: atualização 2022.

21 Jan, 2022 | 15:48h

Perioperative Guidelines on Antiplatelet and Anticoagulant Agents: 2022 Update – Current Anesthesiology Reports

---

M-A | Em sobreviventes de parada cardíaca em coma, a hipotermia não está associada com melhora na sobrevida ou com melhores desfechos neurológicos vs. normotermia.

21 Jan, 2022 | 15:30h

Targeted Hypothermia Versus Targeted Normothermia In Survivors of Cardiac Arrest: A Systematic Review and Meta-Analysis of Randomized Trials – American Journal of Medicine

Conteúdos relacionados:

RCT: In comatose survivors of out-of-hospital cardiac arrest, there was no difference in mortality and neurologic outcomes with mild (target temperature of 34 °C) vs. moderate therapeutic hypothermia (target temperature of 31 °C).

M-A: Targeted temperature management following out-of-hospital cardiac arrest – “Routine use of moderate or deep hypothermia in comatose survivors of OHCA may potentially be associated with more harm than benefit”.

RCT: In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not improve outcomes.

---

Estudo randomizado | Em pacientes não críticos internados com COVID-19, o uso de inibidor de P2Y12 (ticagrelor em 63% dos pacientes e clopidogrel em 37%) adicionado à dose terapêutica de heparina não melhorou a sobrevida livre de suporte de órgãos em comparação à heparina terapêutica isolada.

20 Jan, 2022 | 22:21h

Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Non–Critically Ill Hospitalized Patients With COVID-19: A Randomized Clinical Trial – JAMA

Editorial: Antiplatelet Therapy in Patients With COVID-19—More Is Less? – JAMA

Comentário: Adding a P2Y12 Inhibitor Does Not Improve Outcomes in COVID-19 – HealthDay

---

Estudo randomizado | Em adultos com doença crítica, o uso de solução balanceada de multieletrólitos não reduziu o risco de morte ou lesão renal aguda em comparação à solução salina padrão.

20 Jan, 2022 | 22:05h

Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults – New England Journal of Medicine (link para o resumo – $ para o texto completo)

Comentário: Australian study set to guide the treatment of critically ill patients worldwide – George Institute for Global Health

Conteúdos relacionados:

BaSICS RCT: Among critically ill patients requiring fluid therapy, treatment with a balanced solution did not lead to reduced mortality compared to a 0.9% saline solution.

BaSICS RCT: Among critically ill patients requiring fluid therapy, there was no difference in mortality with slower (333 mL/h) vs. faster (999 mL/h) intravenous fluid bolus rates.

Cochrane Review: Buffered Solutions Do Not Improve Mortality in Critically Ill Adults and Children Compared to 0,9% Saline

 

Comentário no Twitter

Trial of critically ill patients compared balanced multielectrolyte solution (BMES) with saline as fluid therapy in the ICU. There was no evidence that the risk of death or acute kidney injury was lower with the use of BMES than with saline. https://t.co/bmlg4BYaw8 pic.twitter.com/OlKGOM0Dmm

— NEJM (@NEJM) January 18, 2022

 

---

M-A | Avaliação de intervenções para reduzir a prescrição de opioides para pacientes após alta do departamento de emergência.

20 Jan, 2022 | 21:40h

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department: A Systematic Review and Meta-analysis – JAMA Network Open

Comentário convidado: Optimizing Opioid Prescriptions for Patients in the Emergency Department—How Much Is Almost Never? – JAMA Network Open

 

Comentário no Twitter

This meta-analysis of 63 studies showed that most interventions were able to reduce opioid prescription rates but not the prescribed opioid quantity for ED-discharged patients. Almost no data on patients-centered outcomes were assessed in these studies. https://t.co/Cd1D7EjCkI

— JAMA Network Open (@JAMANetworkOpen) January 13, 2022

 

---

Evidências atualizadas da Cochrane sobre COVID-19.

20 Jan, 2022 | 21:33h

COVID-19 evidence: a Cochrane round-up – Cochrane Library

---

Diretriz ACP | Diagnóstico e tratamento da diverticulite colônica aguda de lado esquerdo.

20 Jan, 2022 | 21:09h

Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians – Annals of Internal Medicine

Diretriz relacionada: Colonoscopy for Diagnostic Evaluation and Interventions to Prevent Recurrence After Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians – Annals of Internal Medicine

Revisões sistemáticas relacionadas:

Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis: A Systematic Review – Annals of Internal Medicine

Evaluation and Management After Acute Left-Sided Colonic Diverticulitis: A Systematic Review – Annals of Internal Medicine

Resumo em vídeo: Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis: A Systematic Review – Annals of Internal Medicine

Comunicado de imprensa: ACP releases two new clinical guidelines on the diagnosis and management of diverticulitis – American College of Physicians

---

OMS recomenda dois novos medicamentos (baricitinibe e sotrovimabe) para tratar COVID-19.

20 Jan, 2022 | 20:20h

Comunicado de imprensa: WHO recommends two new drugs to treat COVID-19 – World Health Organization

Infográfico com recomendações atualizadas: A living WHO guideline on drugs for covid-19 – The BMJ

Comentários:

WHO Recommends Two New COVID-19 Treatments – Cost and Availability Likely Barriers – Health Policy Watch

Expert reaction to WHO recommending two drugs, sotrovimab and baricitinib, to treat patients with COVID-19 – Science Media Centre

 

Comentário no Twitter (fio – clique para saber mais)

WHO has also conditionally recommended the use of sotrovimab for treating mild or moderate #COVID19 in patients who are at high risk of hospitalization: patients who are older, immunocompromised, with underlying conditions & those unvaccinated https://t.co/UAc21Wgxbl https://t.co/Z39mSKrOv5

— World Health Organization (WHO) (@WHO) January 14, 2022

 

---

Ponto de vista | Tratamentos para COVID-19 para pacientes não internados.

20 Jan, 2022 | 20:11h

COVID-19 Therapeutics for Nonhospitalized Patients – JAMA

Editorial: Realizing the Potential of Anti–SARS-CoV-2 Monoclonal Antibodies for COVID-19 Management – JAMA

---