Oleksa G Rewa1, Pierre-Marc Villeneuve2, Philippe Lachance2, Dean T Eurich3, Henry T Stelfox4, R T Noel Gibney2, Lisa Hartling5, Robin Featherstone5, Sean M Bagshaw2. 1. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada. rewa@ualberta.ca. 2. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada. 3. 2-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada. 4. Department of Critical Care Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. 5. Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 4-486D Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
Abstract
OBJECTIVES: Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively invasive and resource intensive technology, there remains wide practice variation in its application. This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients. DESIGN: A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources. Two reviewers independently screened, selected, and extracted data using standardized forms. Each retrieved citation was appraised for quality using the Newcastle-Ottawa Scale (NOS) and Cochrane risk of bias tool. Data were summarized narratively. MEASUREMENTS AND MAIN RESULTS: Our search yielded 8374 citations, of which 133 fulfilled eligibility. This included 97 cohort studies, 24 randomized controlled trials, 10 case-control studies, and 2 retrospective medical audits. The quality of retrieved studies was generally good. In total, 18 QIs were identified that were mentioned in 238 instances. Identified QIs were classified as related to structure (n = 4, 22.2 %), care processes (n = 9, 50.0 %), and outcomes (n = 5, 27.8 %). The most commonly mentioned QIs focused on filter lifespan (n = 98), small solute clearance (n = 46), bleeding (n = 30), delivered dose (n = 19), and treatment interruption (n = 5). Across studies, the definitions used for QIs evaluating similar constructs varied considerably. When identified, QIs were most commonly described as important (n = 144, 48.3 %), scientifically acceptable (n = 32, 10.7 %), and useable and/or feasible (n = 17, 5.7 %) by their primary study authors. CONCLUSIONS: We identified numerous potential QIs of CRRT care, characterized by heterogeneous definitions, varying quality of derivation, and limited evaluation. Further study is needed to prioritize a concise inventory of QIs to measure, improve, and benchmark CRRT care for critically ill patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015015530.
OBJECTIVES: Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively invasive and resource intensive technology, there remains wide practice variation in its application. This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients. DESIGN: A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources. Two reviewers independently screened, selected, and extracted data using standardized forms. Each retrieved citation was appraised for quality using the Newcastle-Ottawa Scale (NOS) and Cochrane risk of bias tool. Data were summarized narratively. MEASUREMENTS AND MAIN RESULTS: Our search yielded 8374 citations, of which 133 fulfilled eligibility. This included 97 cohort studies, 24 randomized controlled trials, 10 case-control studies, and 2 retrospective medical audits. The quality of retrieved studies was generally good. In total, 18 QIs were identified that were mentioned in 238 instances. Identified QIs were classified as related to structure (n = 4, 22.2 %), care processes (n = 9, 50.0 %), and outcomes (n = 5, 27.8 %). The most commonly mentioned QIs focused on filter lifespan (n = 98), small solute clearance (n = 46), bleeding (n = 30), delivered dose (n = 19), and treatment interruption (n = 5). Across studies, the definitions used for QIs evaluating similar constructs varied considerably. When identified, QIs were most commonly described as important (n = 144, 48.3 %), scientifically acceptable (n = 32, 10.7 %), and useable and/or feasible (n = 17, 5.7 %) by their primary study authors. CONCLUSIONS: We identified numerous potential QIs of CRRT care, characterized by heterogeneous definitions, varying quality of derivation, and limited evaluation. Further study is needed to prioritize a concise inventory of QIs to measure, improve, and benchmark CRRT care for critically ill patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015015530.
Authors: Eric A J Hoste; Sean M Bagshaw; Rinaldo Bellomo; Cynthia M Cely; Roos Colman; Dinna N Cruz; Kyriakos Edipidis; Lui G Forni; Charles D Gomersall; Deepak Govil; Patrick M Honoré; Olivier Joannes-Boyau; Michael Joannidis; Anna-Maija Korhonen; Athina Lavrentieva; Ravindra L Mehta; Paul Palevsky; Eric Roessler; Claudio Ronco; Shigehiko Uchino; Jorge A Vazquez; Erick Vidal Andrade; Steve Webb; John A Kellum Journal: Intensive Care Med Date: 2015-07-11 Impact factor: 17.440
Authors: Raymond K Hsu; Charles E McCulloch; R Adams Dudley; Lowell J Lo; Chi-yuan Hsu Journal: J Am Soc Nephrol Date: 2012-12-06 Impact factor: 10.121
Authors: Paul M Palevsky; Jane Hongyuan Zhang; Theresa Z O'Connor; Glenn M Chertow; Susan T Crowley; Devasmita Choudhury; Kevin Finkel; John A Kellum; Emil Paganini; Roland M H Schein; Mark W Smith; Kathleen M Swanson; B Taylor Thompson; Anitha Vijayan; Suzanne Watnick; Robert A Star; Peter Peduzzi Journal: N Engl J Med Date: 2008-05-20 Impact factor: 91.245
Authors: Henry T Stelfox; Daniel J Niven; Fiona M Clement; Sean M Bagshaw; Deborah J Cook; Emily McKenzie; Melissa L Potestio; Christopher J Doig; Barbara O'Neill; David Zygun Journal: PLoS One Date: 2015-10-22 Impact factor: 3.240
Authors: Sean M Bagshaw; Michael Darmon; Marlies Ostermann; Fredric O Finkelstein; Ron Wald; Ashita J Tolwani; Stuart L Goldstein; David J Gattas; Shigehiko Uchino; Eric A Hoste; Stephane Gaudry Journal: Intensive Care Med Date: 2017-03-13 Impact factor: 17.440
Authors: Peter Pickkers; Marlies Ostermann; Michael Joannidis; Alexander Zarbock; Eric Hoste; Rinaldo Bellomo; John Prowle; Michael Darmon; Joseph V Bonventre; Lui Forni; Sean M Bagshaw; Miet Schetz Journal: Intensive Care Med Date: 2017-01-30 Impact factor: 17.440
Authors: Alain Combes; Daniel Brodie; Nadia Aissaoui; Thomas Bein; Gilles Capellier; Heidi J Dalton; Jean-Luc Diehl; Stefan Kluge; Daniel F McAuley; Matthieu Schmidt; Arthur S Slutsky; Samir Jaber Journal: Intensive Care Med Date: 2022-08-09 Impact factor: 41.787
Authors: Kianoush Kashani; Mitchell Howard Rosner; Michael Haase; Andrew J P Lewington; Donal J O'Donoghue; F Perry Wilson; Mitra K Nadim; Samuel A Silver; Alexander Zarbock; Marlies Ostermann; Ravindra L Mehta; Sandra L Kane-Gill; Xiaoqiang Ding; Peter Pickkers; Azra Bihorac; Edward D Siew; Erin F Barreto; Etienne Macedo; John A Kellum; Paul M Palevsky; Ashita Jiwat Tolwani; Claudio Ronco; Luis A Juncos; Oleksa G Rewa; Sean M Bagshaw; Theresa Ann Mottes; Jay L Koyner; Kathleen D Liu; Lui G Forni; Michael Heung; Vin-Cent Wu Journal: Clin J Am Soc Nephrol Date: 2019-05-17 Impact factor: 8.237
Authors: James M Tatum; Galinos Barmparas; Ara Ko; Navpreet Dhillon; Eric Smith; Daniel R Margulies; Eric J Ley Journal: JAMA Surg Date: 2017-10-01 Impact factor: 14.766