过敏反应是一种迅速进展的危及生命的综合症,表现为瘙痒,荨麻疹,血管性水肿,支气管痉挛和休克。这次综合审查的目的是提供一种实用的,更新了这种疾病和相关并发症的评估和管理方法。
用过敏反应的MeSH进行了MEDLINE搜索,过敏反应,过敏性休克,难治性过敏反应和诊断副标题,分类,流行病学,并发症和药理学。支持干预的证据水平是根据随机研究的可用性进行评估的。专家意见,案例研究,reviews,实践参数和其他数据库(包括Cochrane)。
描述过敏反应的精选出版物,临床试验,诊断,机制,检索了风险因素和管理(综述,指导方针,临床试验,案例系列)及其参考书目也进行了审查,以确定相关出版物。
审查了相关出版物的数据,总结和综合信息。
这是一项综合综述,从文献综述中获得的数据用于描述过敏反应患者的诊断和管理的当前趋势,特别强调过敏反应终型和表型的新概念。ICU环境中难治性过敏反应的管理和老年患者的治疗选择的审查,或患有严重心肺并发症的复杂患者。大多数建议来自实践参数,案例研究或专家意见,缺乏支持特定干预措施的随机试验。
过敏反应是一种快速进展的危及生命的疾病。重症监护医生需要熟悉诊断,鉴别诊断,评估,和过敏反应的管理。对于复杂的患者,可能需要对ICU进行熟练的干预,严重,或难治性过敏反应。
Anaphylaxis is a rapidly progressive life-threatening syndrome manifesting as pruritus, urticaria, angioedema, bronchospasm and shock. The goal of this synthetic
review is to provide a practical, updated approach to the evaluation and management of this disorder and associated complications.
A MEDLINE search was conducted with the MeSH of anaphylaxis, anaphylactic reaction, anaphylactic shock, refractory anaphylaxis and subheadings of diagnosis, classification, epidemiology, complications and pharmacology. The level of evidence supporting an intervention was evaluated based on the availability of randomized studies, expert opinion, case studies, reviews, practice parameters and other databases (including Cochrane).
Selected publications describing anaphylaxis, clinical trials, diagnosis, mechanisms, risk factors and management were retrieved (reviews, guidelines, clinical trials, case series) and their bibliographies were also reviewed to identify relevant publications.
Data from the relevant publications were reviewed, summarized and the information synthesized.
This is a synthetic
review and the data obtained from a literature
review was utilized to describe current trends in the diagnosis and management of the patient with anaphylaxis with a special emphasis on newer evolving concepts of anaphylaxis endotypes and phenotypes, management of refractory anaphylaxis in the ICU setting and
review of therapeutic options for the elderly patient, or the complicated patient with severe cardiorespiratory complications. Most of the recommendations come from practice parameters, case studies or expert opinions, with a dearth of randomized trials to support specific interventions.
Anaphylaxis is a rapidly progressive life-threatening disorder. The critical care physician needs to be familiar with the diagnosis, differential diagnosis, evaluation, and management of anaphylaxis. Skilled intervention in ICUs may be required for the patient with complicated, severe, or refractory anaphylaxis.