Abordagem da Síndrome BRASH no departamento de emergência: Revisão sistemática de escopo
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Resumen
A síndrome BRASH é uma condição grave que combina bradicardia, insuficiência renal, bloqueio do nó AV, choque e hipercalemia, levando a um ciclo de retroalimentação potencialmente fatal se não tratada rapidamente. O diagnóstico e tratamento adequados são essenciais, pois diferem de outras condições semelhantes, requerendo uma abordagem específica para evitar complicações severas. Tendo isso em vista, a presente revisão objetiva sintetizar e analisar criticamente os estudos publicados sobre a síndrome até o momento, com enfoque em seu manejo no departamento de emergência. Para isso foi realizada uma revisão sistemática de escopo, seguindo a diretriz PRISMA-ScR, nas plataformas Scholar google, LILACS e Pubmed, incluindo artigos de 2018-2024. Foram incluídos 35 estudos, totalizando uma amostra de 40 pacientes. A média de idade foi de 76 anos, com maioria dos pacientes do sexo feminino (65,0%). As classes medicamentosas que mais causaram a síndrome foram os betabloqueadores (80,0%), com destaque para o carvedilol (42,5%) e os bloqueadores dos canais de cálcio (60,0%) com destaque para o anlodipino (30,0%). A principal alteração eletrocardiográfica encontrada foi a bradicardia juncional (50%) e maioria dos pacientes se beneficiou com o uso de terapia de suporte com enfoque no controle da hiperpotassemia e do choque hemodinâmico. São necessários mais estudos robustos para melhor identificar os fatores de risco, tratamentos mais eficazes e segurança do retorno ao uso de medicações bloqueadoras do nó atrioventricular nesta população.
Detalles del artículo
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