Abstract:
OBJECTIVES:We examined recommendations within critical care guidelines to describe the pairing patterns for strength of recommendation and quality of evidence. We further identified recommendations where the reported strength of recommendation was strong while the reported quality of evidence was not high/moderate and then assessed whether such pairings were within five paradigmatic situations offered by Grading of Recommendations Assessment, Development and Evaluation methodology to justify such pairings. DATA SOURCES AND EXTRACTION:We identified all clinical critical care guidelines published online from 2011 to 2017 by the Society of Critical Care Medicine along with individual guidelines published by Surviving Sepsis Campaign, Kidney Disease Improving Global Outcomes, American Society for Parenteral and Enteral Nutrition, and the Infectious Disease Society of America/American Thoracic Society. DATA SYNTHESIS:In all, 15 documents specifying 681 eligible recommendations demonstrated variation in strength of recommendation (strong n = 215 [31.6%], weak n = 345 [50.7%], none n = 121 [17.8%]) and in quality of evidence (high n = 41 [6.0%], moderate n = 151 [22.2%], low/very low n = 298 [43.8%], and Expert Consensus/none n = 191 [28.1%]). Strength of recommendation and quality of evidence were positively correlated (ρ = 0.66; p < 0.0001). Of 215 strong recommendations, 69 (32.1%) were discordantly paired with evidence other than high/moderate. Twenty-two of 69 (31.9%) involved Strong/Expert Consensus recommendations, a category discouraged by Grading of Recommendations Assessment, Development and Evaluation methodology. Forty-seven of 69 recommendations (68.1%) were comprised of Strong/Low or Strong/Very Low variation requiring justification within five paradigmatic scenarios. Among distribution in the five paradigmatic scenarios of Strong/Low and Strong/Very Low recommendations, the most common paradigmatic scenario was life threatening situation (n = 20/47; 42.6%). Four Strong/Low or Strong/Very Low recommendations (4/47; 8.5%) were outside Grading of Recommendations Assessment, Development and Evaluation methodology. CONCLUSIONS:Among a large, diverse assembly of critical care guideline recommendations using Grading of Recommendations Assessment, Development and Evaluation methodology, the strength of evidence of a recommendation was generally associated with the quality of evidence. However, strong recommendations were not infrequently made in the absence of high/moderate quality of evidence. To improve clarity and uptake, future guideline statements may specify why such pairings were made, avoid such pairings when outside of Grading of Recommendations Assessment, Development and Evaluation criteria, and consider separate language for Expert Consensus recommendations (good practice statements).
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Sims CR,Warner MA,Stelfox HT,Hyder JAdoi
10.1097/CCM.0000000000003467subject
Has Abstractpub_date
2019-01-01 00:00:00pages
109-113issue
1eissn
0090-3493issn
1530-0293journal_volume
47pub_type
杂志文章abstract:OBJECTIVE:To evaluate the efficacy and tolerability of intravenous empiric treatment with meropenem compared with ceftazidime-tobramycin in patients with hospital-acquired lower respiratory tract infections. DESIGN:Prospective, nonblind, randomized trial. SETTING:Multicenter trial conducted at 22 centers. PATIENTS:T...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199710000-00015
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To assess the effect of a helium-oxygen mixture on intubation rate and clinical outcomes during noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease. DESIGN:Multicenter, prospective, randomized, controlled trial. SETTING:Seven intensive care units. PATIENTS:A total of 204 ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0b013e3181b78abe
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:Significant mortality in patients with sepsis results from the development of multiple organ dysfunction syndrome. Small-volume resuscitation with 7.5% NaCl hypertonic saline has been proposed to restore physiologic hemodynamics in hemorrhagic shock. Therefore, we hypothesized that hypertonic saline resuscita...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318173f982
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVES:To investigate pharmacokinetics and metabolism of sodium citrate in critically ill patients. To determine the risk of citrate accumulation in the setting of liver dysfunction (cirrhosis, hepatorenal syndrome). DESIGN:Prospective cohort study. SETTING:Intensive Care Unit, Department of Medicine IV, Universi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000084871.76568.E6
更新日期:2003-10-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828cf0c0
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:To determine the effect that acute physiologic derangements have on outcome after subarachnoid hemorrhage (SAH) and to design a composite score summarizing these abnormalities. DESIGN:Prospective observational study. SETTING:Neuroscience intensive care unit in a tertiary care academic center. PATIENTS:Cons...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000114830.48833.8a
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:Oxygenation measured 24 hours after acute respiratory distress syndrome onset more accurately stratifies risk, relative to oxygenation at onset, in both children and adults. However, waiting 24 hours is problematic, especially for interventions that are more efficacious early in the disease course. We aimed t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002958
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVES:Increasing age is a well-recognized risk factor for in-hospital mortality in patients receiving extracorporeal membrane oxygenation for cardiogenic shock, but the shape of this relationship is unknown. In addition, the impact of age on hospital length of stay, patterns of patient disposition, and costs has b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003631
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVES:Case fatality in pregnancy-associated severe sepsis or septic shock appears reduced compared with nonpregnant women with severe sepsis or septic shock. It remains unclear if this difference is due to pregnancy or better baseline health status, among others. Our study compared adverse outcomes of pregnancy-as...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003348
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVES:Randomized trials have suggested that hypertonic saline solutions may be superior to mannitol for the treatment of elevated intracranial pressure, but their impact on clinical practice has been limited, partly by their small size. We therefore combined their findings in a meta-analysis. DATA SOURCES:We sear...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0b013e318206b9be
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:Sympathetic vasoconstriction regulates peripheral circulation and controls blood pressure, but sepsis is associated with hypotension. We evaluated whether apparent loss of sympathetic vasoconstrictor responsiveness relates to distended smooth muscles or to endotoxemia and/or hypoxia. DESIGN:Prospective descr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001486
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:To assess whether the delivered nitric oxide (NO) concentration is affected by a change in the ventilatory setting during neonatal mechanical ventilatory support. DESIGN:Prospective, experimental study. SETTING:Laboratory at Nagoya City University Medical School. INTERVENTIONS:This study was performed by u...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200005000-00058
更新日期:2000-05-01 00:00:00
abstract::We found that altering aspirating flow rate (ASR) and sample tubing length (STL) affected the response time and capnogram of 2 different side-stream capnometers. Increased flow rate shortened rise time, transit time, and total delay time (TDT), whereas increased STL increased transit and TDTs but not rise time. Increa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198408000-00015
更新日期:1984-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. DESIGN:Retrospective analysis of 49 consecutive patient...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000181730.02238.9b
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVES:With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. DES...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001200
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVES:To examine the effect of extracorporeal membrane oxygenation (ECMO) therapy on platelet function and number and to determine the in vivo survival of transfused platelets during ECMO. DESIGN:Prospective study of all neonates treated with ECMO during a 6-month period. SETTING:Neonatal intensive care unit in ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199307000-00018
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVES:To review mechanisms underlying sepsis-induced cardiac dysfunction in general and intrinsic myocardial depression in particular. DATA SOURCE:MEDLINE database. DATA SYNTHESIS:Myocardial depression is a well-recognized manifestation of organ dysfunction in sepsis. Due to the lack of a generally accepted defi...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000266683.64081.02
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVE:We hypothesized that the extent of injury and release of xanthine oxidase, an oxidant generator, into the circulation would be less in normal-flow hypoxia-reoxygenation than in equal duration no-flow ischemia-reperfusion. DESIGN:Randomized study. SETTING:University-based animal research facility. SUBJECTS:...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199806000-00034
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:To determine the risk factors for development of severe hypoglycemia (defined as glucose <40 mg/dL) in critically ill patients and define the outcomes of this complication. DESIGN:Retrospective database review, including a case-control analysis that matched each patient with severe hypoglycemia with three co...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000282073.98414.4B
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVES:To develop a valid, reliable measure that reflected the environment of respectfulness within the ICU setting. DESIGN:We developed a preliminary survey instrument based on conceptual domains of respect identified through prior qualitative analyses of ICU patient, family member, and clinician perspectives. Th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003069
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:To review the incidence, diagnosis, and management of septic emboli caused by vascular catheters after surgery for congenital heart disease. DESIGN:Retrospective clinical review. All patients were computer registered. Our database includes daily follow-up and every sign of infection registered. SETTING:Pedi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200003000-00039
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the reproducibility and accuracy of a new pulmonary artery catheter system that provides both right ventricular ejection fraction and continuous venous oxygen saturation monitoring. DESIGN:Criterion standard study. SETTING:University medical center. PATIENTS:A consecutive sample of ten patients...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199212000-00008
更新日期:1992-12-01 00:00:00
abstract:OBJECTIVES:Lung CT is the reference imaging technique for acute respiratory distress syndrome, but requires transportation outside the intensive care and x-ray exposure. Lung ultrasound is a promising, inexpensive, radiation-free, tool for bedside imaging. Aim of the present study was to compare the global and regional...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003971
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVES:To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities. DESIGN:Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017. SETTING:ICUs in 12 U.S. acute ca...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004344
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the effect of a neutrophil elastase inhibitor, sivelestat, on lipopolysaccharide-induced acute lung injury through analysis of hemodynamic changes in the pulmonary microcirculation. DESIGN:Randomized animal study. SETTING:Medical school laboratory. SUBJECTS:Twenty-...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000172547.54086.ad
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVES:To describe the effectiveness of a comprehensive, interdisciplinary sepsis treatment protocol with regard to both implementation and outcomes and to compare the mortality rates and therapies of patients with septic shock with similar historical controls. DESIGN:Prospective, interventional cohort study with ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000206104.18647.A8
更新日期:2006-04-01 00:00:00
abstract:OBJECTIVE:To determine the association of pulmonary artery catheter (PAC) use with in-hospital mortality. DESIGN:Prospective, observational study. SETTING:The medical intensive care units (MICU) of two teaching hospitals. METHODS:The study included 751 adults who were admitted to the MICU, excluding those who stayed...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200106000-00010
更新日期:2001-06-01 00:00:00
abstract:OBJECTIVE:To examine the efficacy of iontophoretic delivery of calcium to experimental hydrofluoric acid burns. DESIGN:Prospective, controlled study. SETTING:Institutional laboratory. SUBJECTS:Male nude rats. INTERVENTIONS:For the in vitro experiment, a full-thickness skin from the back was set in a vertical flow-t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200108000-00013
更新日期:2001-08-01 00:00:00
abstract:OBJECTIVE:To test the effects of three hemoglobin solutions on liver function and hepatic morphology after resuscitation from severe hemorrhagic shock. DESIGN:Prospective study. SETTING:Laboratory. SUBJECTS:Thirty-three beagle dogs. INTERVENTION:Hemorrhagic shock was induced in anesthetized dogs by removal of blood...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199604000-00019
更新日期:1996-04-01 00:00:00
abstract:OBJECTIVES:Although the mortality of severe sepsis is easily quantified, the actual cause and timing of death from severe sepsis are less defined. We used the INDEPTH (International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa activated) database to investigate the reported cause of deat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820eda29
更新日期:2011-05-01 00:00:00