Expert consensus on the clinical treatment of burn patients complicated with Coronavirus infection (2023 version)
-
摘要: 随着新型冠状病毒感染（COVID-19）实施“乙类乙管”，全国多地出现多波次大量COVID-19病例，新型冠状病毒对机体的长期影响也逐步被重视。烧伤合并COVID-19的临床救治仍是我国烧伤救治机构面临的一大挑战，如何规范此类患者的临床救治，最大限度地改善预后，并为未来类似传染病提供经验，显得尤为必要。为此，中华医学会烧伤外科学分会、中国医疗保健国际交流促进会烧伤医学分会、《中华烧伤与创面修复杂志》编辑委员会共同发起并组织多学科专家，基于目前的循证医学证据、临床实践和其他学科权威指南，制订了该共识，以期规范烧伤合并COVID-19患者的临床救治。Abstract: With China downgrading the management of Coronavirus infection (COVID-19) from Category A to Category B, a large number of COVID-19 patients have occurred in multiple waves across the country. Meanwhile, the long-term impact of Coronavirus on the body has gradually been noticed. However, the clinical treatment of burns complicated with COVID-19 is still a major challenge in Chinese burn centers. It is then essential to standardize the clinical treatment of such patients, improve the prognosis to the greatest extent, and provide valuable experiences for similar infectious diseases in future. Therefore, Chinese Burn Association, Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare, and Editorial Committee of Chinese Journal of Burns and Wounds jointly initiated and organized multidisciplinary experts to develop this expert consensus based on the current medical evidence, clinical practice, and authoritative guidelines of other disciplines, in order to standardize the clinical treatment of burn patients complicated with COVID-19.
-
Key words:
- Burns /
- Coronavirus infection /
- Expert consensus
-
1 《烧伤合并新型冠状病毒感染临床救治专家共识（2023版）》的专家推荐意见流程图
注：COVID-19为新型冠状病毒感染，VTE为静脉血栓栓塞烧伤合并新型冠状病毒感染临床救治专家共识（2023版）编写组
表1 牛津大学循证医学中心新5级证据分级标准和本共识推荐强度标准
项目与类别 具体描述 证据级别 Ⅰa 基于多个RCT的系统评价，且文献的同质性好 Ⅰb 单个RCT研究，且可信区间窄 Ⅰc 全或无的病例系列报告 Ⅱa 基于多个队列研究的系统评价 Ⅱb 单个队列研究或质量较差的RCT Ⅱc 结局研究或病因学研究 Ⅲa 病例对照研究的系统评价 Ⅲb 病例对照研究 Ⅳ 单个病例系列研究 Ⅴ 专家意见 推荐强度 强 ≥50%专家意见为“强烈同意” 中 <50%专家意见为“强烈同意”，但“强烈同意+同意”比例>50% 弱 “强烈同意+同意”比例≤50% 注：RCT为随机对照试验 
下载: 导出CSV
-
[1] 国家卫生健康委办公厅 国家中医药局综合司 关于印发新型冠状病毒感染诊疗方案(试行第十版)的通知 2023-01-05 2023-05-19 http://www.nhc.gov.cn/ylyjs/pqt/202301/32de5b2ff9bf4eaa88e75bdf7223a65a.shtml 国家卫生健康委办公厅, 国家中医药局综合司. 关于印发新型冠状病毒感染诊疗方案(试行第十版)的通知[EB/OL]. (2023-01-05)[2023-05-19]. http://www.nhc.gov.cn/ylyjs/pqt/202301/32de5b2ff9bf4eaa88e75bdf7223a65a.shtml.
[2] BertrocheJT, PipkornP, ZolkindP, et al. Negative-pressure aerosol cover for COVID-19 tracheostomy[J]. JAMA Otolaryngol Head Neck Surg, 2020,146(7):672-674. DOI: 10.1001/jamaoto.2020.1081. [3] LambCR, DesaiNR, AngelL, et al. Use of tracheostomy during the COVID-19 pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report[J]. Chest, 2020,158(4):1499-1514. DOI: 10.1016/j.chest.2020.05.571. [4] DamarlaH, PangasaN, HirolliD, et al. Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: initial experience[J]. J Anaesthesiol Clin Pharmacol, 2022,38(Suppl 1):S102-106. DOI: 10.4103/joacp.joacp_495_21. [5] SilversidesJA, MajorE, FergusonAJ, et al. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis[J]. Intensive Care Med, 2017,43(2):155-170. DOI: 10.1007/s00134-016-4573-3. [6] MeyhoffTS, MøllerMH, HjortrupPB, et al. Lower vs higher fluid volumes during initial management of sepsis: a systematic review with meta-analysis and trial sequential analysis[J]. Chest, 2020,157(6):1478-1496. DOI: 10.1016/j.chest.2019.11.050. [7] SilversidesJA, McMullanR, EmersonLM, et al. Feasibility of conservative fluid administration and deresuscitation compared with usual care in critical illness: the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) randomised clinical trial[J]. Intensive Care Med, 2022,48(2):190-200. DOI: 10.1007/s00134-021-06596-8. [8] AlhazzaniW, MøllerMH, ArabiYM, et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19)[J]. Crit Care Med, 2020, 48(6):e440-e469. DOI: 10.1097/CCM.0000000000004363. [9] HoltDB, LardaroT, WangAZ, et al. Fluid resuscitation and progression to renal replacement therapy in patients with COVID-19[J]. J Emerg Med, 2022,62(2):145-153. DOI: 10.1016/j.jemermed.2021.10.026. [10] MatsumuraY, SugiyamaT, KondoN, et al. Fluid restriction management in the treatment of COVID-19: a single-center observational study[J]. Sci Rep, 2022,12(1):17339. DOI: 10.1038/s41598-022-22389-5. [11] 孙莹, 翟茜. 重症新型冠状病毒肺炎患者的容量管理[J/OL].中华重症医学电子杂志(网络版),2020,6(3):335-338[2023-05-19]. https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjMwNDI2Ehd6aHp6eXhkenp6LXdsYjIwMjAwMzAxOBoIMTkzd3J3YTE%3D. DOI: 10.3877/cma.j.issn.2096-1537.2020.03.018. [12] 张家平, 向飞, 童大力, 等. 限制性液体管理策略对严重烧伤患者早期肺功能影响的对比研究[J].中华烧伤杂志,2012,28(3):165-169. DOI: 10.3760/cma.j.issn.1009-2587.2012.03.002. [13] 王志勇, 冯世海, 范宝莉, 等. 导向性限制性液体管理策略对严重烧伤合并重度吸入性损伤患者的影响[J].中华烧伤杂志,2019,35(7):501-506. DOI: 10.3760/cma.j.issn.1009-2587.2019.07.005. [14] GriffithsM, McAuleyDF, PerkinsGD, et al. Guidelines on the management of acute respiratory distress syndrome[J]. BMJ Open Respir Res, 2019,6(1):e000420. DOI: 10.1136/bmjresp-2019-000420. [15] AbbottT, FowlerAJ, DobbsTD, et al. Mortality after surgery with SARS-CoV-2 infection in England: a population-wide epidemiological study[J]. Br J Anaesth, 2021,127(2):205-214. DOI: 10.1016/j.bja.2021.05.018. [16] CollaborativeCOVIDSurg. Outcomes and their state-level variation in patients undergoing surgery with perioperative SARS-CoV-2 infection in the USA: a prospective multicenter study[J]. Ann Surg, 2022,275(2):247-251. DOI: 10.1097/SLA.0000000000005310. [17] CollaborativeCOVIDSurg, CollaborativeGlobalSurg. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study[J]. Anaesthesia, 2021,76(6):748-758. DOI: 10.1111/anae.15458. [18] El-BoghdadlyK, CookTM, GoodacreT, et al. Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update: a multidisciplinary consensus statement on behalf of the Association of Anaesthetists, Centre for Perioperative Care, Federation of Surgical Specialty Associations, Royal College of Anaesthetists, Royal College of Surgeons of England[J]. Anaesthesia, 2022,77(5):580-587. DOI: 10.1111/anae.15699. [19] BariePS, BrindleME, KhadarooRG, et al. Omicron, long-COVID, and the safety of elective surgery for adults and children: joint guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services[J]. Surg Infect (Larchmt), 2023,24(1):6-18. DOI: 10.1089/sur.2022.274. [20] UppalV, SondekoppamRV, LandauR, et al. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations[J]. Anaesthesia, 2020,75(10):1350-1363. DOI: 10.1111/anae.15105. [21] Mejía-TerrazasGE, López-MuñozE, Vilchis-RenteríaJS, et al. COVID-19: regional anesthesia, benefits, and practical recommendations[J]. Asian J Anesthesiol, 2021,59(3):83-95. DOI: 10.6859/aja.202109_59(3).0002. [22] CollaborativeCOVIDSurg, CollaborativeGlobalSurg. Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study[J]. Anaesthesia, 2021,76(11):1454-1464. DOI: 10.1111/anae.15560. [23] CollaborativeCOVIDSurg. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study[J]. Lancet, 2020,396(10243):27-38. DOI: 10.1016/S0140-6736(20)31182-X. [24] WangB, ChenruW, JiangY, et al. Incidence and mortality of acute respiratory distress syndrome in patients with burns: a systematic review and meta-analysis[J]. Front Med (Lausanne), 2021,8:709642. DOI: 10.3389/fmed.2021.709642. [25] TzotzosSJ, FischerB, FischerH, et al. Incidence of ARDS and outcomes in hospitalized patients with COVID-19: a global literature survey[J]. Crit Care, 2020,24(1):516. DOI: 10.1186/s13054-020-03240-7. [26] FossaliT, PavlovskyB, OttolinaD, et al. Effects of prone position on lung recruitment and ventilation-perfusion matching in patients with COVID-19 acute respiratory distress syndrome: a combined CT scan/electrical impedance tomography study[J]. Crit Care Med, 2022,50(5):723-732. DOI: 10.1097/CCM.0000000000005450. [27] 中华医学会呼吸病学分会呼吸危重症医学学组. 急性呼吸窘迫综合征患者机械通气指南(试行)[J].中华医学杂志,2016,96(6):404-424. DOI: 10.3760/cma.j.issn.0376-2491.2016.06.002. [28] 中国老年医学学会烧创伤分会, 中华医学会烧伤外科学分会重症学组. 成人烧伤俯卧位治疗全国专家共识(2022版)[J].中华烧伤与创面修复杂志,2022,38(7):601-609. DOI: 10.3760/cma.j.cn501120-20211208-00407. [29] FanE, Del SorboL, GoligherEC, et al. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2017,195(9):1253-1263. DOI: 10.1164/rccm.201703-0548ST. [30] ShresthaDB, SedhaiYR, BudhathokiP, et al. Pulmonary barotrauma in COVID-19: a systematic review and meta-analysis[J]. Ann Med Surg (Lond), 2022,73:103221. DOI: 10.1016/j.amsu.2021.103221. [31] Valente BarbasCS, Marini IsolaA, BaldisserottoS. Worsening COVID-19 acute respiratory distress syndrome: pneumomediastinum?[J]. Crit Care Med, 2023,51(1):145-148. DOI: 10.1097/CCM.0000000000005733. [32] 中华医学会呼吸病学分会, 中国医师协会呼吸医师分会危重症医学专家组. 奥密克戎变异株所致重症新型冠状病毒感染临床救治专家推荐意见[J].中华结核和呼吸杂志,2023,46(2):101-110. DOI: 10.3760/cma.j.cn112147-20221230-00994. [33] LorussoR, De PieroME, MarianiS, et al. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study[J]. Lancet Respir Med, 2023,11(2):151-162. DOI: 10.1016/S2213-2600(22)00403-9. [34] SchmidtM, HajageD, LandollM, et al. Comparative outcomes of extracorporeal membrane oxygenation for COVID-19 delivered in experienced European centres during successive SARS-CoV-2 variant outbreaks (ECMO-SURGES): an international, multicentre, retrospective cohort study[J]. Lancet Respir Med, 2023,11(2):163-175. DOI: 10.1016/S2213-2600(22)00438-6. [35] HengX, CaiP, YuanZ, et al. Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis[J/OL]. Burns Trauma, 2023,11:tkac056[2023-05-19]. https://pubmed.ncbi.nlm.nih.gov/36873286/. DOI: 10.1093/burnst/tkac056. [36] WatanabeA, YasuharaJ, KarubeT, et al. Extracorporeal membrane oxygenation in children with COVID-19: a systematic review and meta-analysis[J]. Pediatr Crit Care Med, 2023,24(5):406-416. DOI: 10.1097/PCC.0000000000003113. [37] PatoneM, MeiXW, HandunnetthiL, et al. Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection[J]. Nat Med, 2022, 28(2):410-422. DOI: 10.1038/s41591-021-01630-0. [38] GawałkoM, Kapłon-CieślickaA, HohlM, et al. COVID-19 associated atrial fibrillation: incidence, putative mechanisms and potential clinical implications[J]. Int J Cardiol Heart Vasc, 2020,30:100631. DOI: 10.1016/j.ijcha.2020.100631. [39] Writing Committee, GluckmanTJ, BhaveNM, et al. 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American College of Cardiology Solution Set Oversight Committee[J]. J Am Coll Cardiol, 2022, 79(17):1717-1756. DOI: 10.1016/j.jacc.2022.02.003. [40] 中国老年医学学会烧创伤分会. 脉搏轮廓心排血量监测技术在严重烧伤治疗中应用的全国专家共识(2018版)[J].中华烧伤杂志,2018,34(11):776-781. DOI: 10.3760/cma.j.issn.1009-2587.2018.11.011. [41] LumlertgulN, BakerE, PearsonE, et al. Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort[J]. Ann Intensive Care, 2022,12(1):118. DOI: 10.1186/s13613-022-01094-6. [42] FolkestadT, BrurbergKG, NordhuusKM, et al. Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis[J]. Crit Care, 2020,24(1):2. DOI: 10.1186/s13054-019-2710-4. [43] NadimMK, ForniLG, MehtaRL, et al. Publisher correction: COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup[J]. Nat Rev Nephrol, 2020,16(12):765. DOI: 10.1038/s41581-020-00372-5. [44] YoonJ, KimY, KymD, et al. Subgroup analysis of continuous renal replacement therapy in severely burned patients[J]. PLoS One, 2017,12(11):e0189057. DOI: 10.1371/journal.pone.0189057. [45] ChungKK, CoatesEC, SmithDJ, et al. High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: a multicenter randomized controlled trial[J]. Crit Care, 2017,21(1):289. DOI: 10.1186/s13054-017-1878-8. [46] ChungKK, LundyJB, MatsonJR, et al. Continuous venovenous hemofiltration in severely burned patients with acute kidney injury: a cohort study[J]. Crit Care, 2009,13(3):R62. DOI: 10.1186/cc7801. [47] YouB, ZhangYL, LuoGX, et al. Early application of continuous high-volume haemofiltration can reduce sepsis and improve the prognosis of patients with severe burns[J]. Crit Care, 2018,22(1):173. DOI: 10.1186/s13054-018-2095-9. [48] MansoryEM, SrigunapalanS, Lazo-LangnerA. Venous thromboembolism in hospitalized critical and noncritical COVID-19 patients: a systematic review and meta-analysis[J]. TH Open, 2021,5(3):e286-e294. DOI: 10.1055/s-0041-1730967. [49] LiuA, MinasianRA, ManiagoE, et al. Venous thromboembolism chemoprophylaxis in burn patients: a literature review and single-institution experience[J]. J Burn Care Res, 2021,42(1):18-22. DOI: 10.1093/jbcr/iraa143. [50] CroninBJ, GodatLN, BerndtsonAE, et al. Anti-Xa guided enoxaparin dose adjustment improves pharmacologic deep venous thrombosis prophylaxis in burn patients[J]. Burns, 2019,45(4):818-824. DOI: 10.1016/j.burns.2019.02.011. [51] LuP, HarmsKA, PaulE, et al. Venous thromboembolism in burns patients: are we underestimating the risk and underdosing our prophylaxis?[J]. J Plast Reconstr Aesthet Surg, 2021, 74(8):1814-1823. DOI: 10.1016/j.bjps.2020.12.011. [52] TingT, LoT, LoW, et al. Inadequate energy and protein intake, underweight and malnutrition are associated with in-hospital mortality among COVID-19 rehabilitation patients during the omicron outbreak in Hong Kong[J]. Aging Med (Milton), 2022,5(3):204-210. DOI: 10.1002/agm2.12220. [53] 中华医学会烧伤外科学分会, 中国医师协会烧伤科医师分会. 烧伤康复治疗指南(2013版)[J].中华烧伤杂志,2013,29(6):497-504. DOI: 10.3760/cma.j.issn.1009-2587.2013.06.001. [54] AndradeSM, Cecília de Araújo Silvestre M, de França EÉT, et al. Efficacy and safety of HD-tDCS and respiratory rehabilitation for critically ill patients with COVID-19 The HD-RECOVERY randomized clinical trial[J]. Brain Stimul, 2022,15(3):780-788. DOI: 10.1016/j.brs.2022.05.006. [55] AmbroseAF, KurraA, TsirakidisL, et al. Rehabilitation and in-hospital mortality in COVID-19 patients[J]. J Gerontol A Biol Sci Med Sci, 2022, 77(4):e148-e154. DOI: 10.1093/gerona/glab321. -
专家共识附件--表1.docx
2023年8期李海胜.mp4
-
点击查看大图
图(1) / 表(1)
计量
- 文章访问数: 494
- HTML全文浏览量: 130
- PDF下载量: 124
- 被引次数: 0
