Pérsico Raquel S, Viana Marina V, Viana Luciana V
Programa de Pos-Graduaçao em Ciencias Medicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Department of Critical Care Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Indian J Crit Care Med. 2022 Jul;26(7):846-852. doi: 10.5005/jp-journals-10071-24244.
The objective of this study is to synthesize the current literature about the relationship between the occurrence of diabetes insipidus (DI), its diagnosis criteria, and management after withdrawal of vasopressin (VP) in critically ill.
This scoping review followed the recommendations of Preferred Reporting Items for Systematic Review and Meta-Analyses for Scoping Review (PRISMA-ScR). The search literature was conducted in MEDLINE and EMBASE databases, until March 2022. A manual search was also conducted in order to include articles that were not identified in the initial search performed in the databases.
The selection of studies and extraction of data were carried out in a paired and independent manner. There was no restriction regarding the language of publication of the included manuscripts.
The analysis included 17 studies (16 case reports and one retrospective cohort). All studies used VP, with a median time of drug infusion of 48 hours (IQR: 16-72) and DI incidence of 1.53%. The diagnosis of DI was based on diuresis output and concomitant hypernatremia or changes in serum sodium concentration, with median time to symptoms onset after discontinuation of VP of 5 hours (IQR: 3-10). The treatment of DI consisted mainly of fluid management and the use of desmopressin.
DI after VP withdrawal was present in 51 patients described in 17 studies, but diagnosis and management varied among each report. Using the available data, we propose a diagnosis suggestion and a flowchart for managing patients with DI after withdrawal of VP in the Intensive Care Unit. Multicentric collaborative research is urgently needed to obtain more quality data on this topic.
Pérsico RS, Viana MV, Viana LV. Diabetes Insipidus after Vasopressin Withdrawal: A Scoping Review. Indian J Crit Care Med 2022;26(7):846-852.
本研究的目的是综合当前有关危重症患者中尿崩症（DI）的发生、诊断标准以及停用血管加压素（VP）后管理的相关文献。
本范围综述遵循系统综述与Meta分析扩展版的首选报告项目（PRISMA-ScR）的建议。检索文献于2022年3月前在MEDLINE和EMBASE数据库中进行。还进行了手动检索，以纳入在数据库初始检索中未识别的文章。
研究的选择和数据的提取以配对且独立的方式进行。纳入手稿的发表语言没有限制。
分析纳入了17项研究（16篇病例报告和1篇回顾性队列研究）。所有研究均使用了VP，药物输注的中位时间为48小时（四分位间距：16 - 72），DI发生率为1.53%。DI的诊断基于尿量输出以及伴随的高钠血症或血清钠浓度变化，停用VP后症状出现的中位时间为5小时（四分位间距：3 - 10）。DI的治疗主要包括液体管理和去氨加压素的使用。
17项研究中描述的51例患者出现了停用VP后的DI，但各报告中的诊断和管理各不相同。利用现有数据，我们提出了危重症监护病房中停用VP后DI患者的诊断建议和管理流程图。迫切需要多中心协作研究以获取关于该主题的更多高质量数据。
Pérsico RS, Viana MV, Viana LV. Vasopressin Withdrawal后尿崩症：一项范围综述。Indian J Crit Care Med 2022;26(7):846 - 852。
