John W Devlin1,2, Yoanna Skrobik3,4,5, Bram Rochwerg6,7, Mark E Nunnally8,9,10,11, Dale M Needham12, Celine Gelinas13, Pratik P Pandharipande14, Arjen J C Slooter15, Paula L Watson16, Gerald L Weinhouse17, Michelle E Kho18, John Centofanti19, Carrie Price20, Lori Harmon21, Cheryl J Misak22, Pamela D Flood23, Waleed Alhazzani7,24. 1. School of Pharmacy, Northeastern University, Boston, MA. 2. Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA. 3. Faculty of Medicine, McGill University, Montreal, QC, Canada. 4. Regroupement de Soins Critiques Respiratoires, Réseau de Santé Respiratoire, Montreal, QC, Canada. 5. Faculty of Medicine, Queen's University, Kingston, ON, Canada. 6. Department of Medicine (Critical Care), McMaster University, Hamilton, ON, Canada. 7. Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada. 8. Division of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, NY. 9. Division of Medicine, New York University Langone Health, New York, NY. 10. Division of Neurology, New York University Langone Health, New York, NY. 11. Division of Surgery, New York University Langone Health, New York, NY. 12. Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD. 13. Ingram School of Nursing, McGill University, Montreal, QC, Canada. 14. Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN. 15. Department of Intensive Care Medicine, Brain Center Rudolf Magnus, University Medical Center, Utrecht University, Utrecht, The Netherlands. 16. Division of Sleep Medicine, Vanderbilt University Medical Center, Nashville, TN. 17. Division of Pulmonary and Critical Care, Brigham and Women's Hospital and School of Medicine, Harvard University, Boston, MA. 18. School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada. 19. Department of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada. 20. Welch Medical Library, Johns Hopkins University, Baltimore, MD. 21. Society of Critical Care Medicine, Mount Prospect, IL. 22. Department of Philosophy, University of Toronto, Toronto, CA. 23. Division of Anesthesiology, Stanford University Hospital, Palo Alto, CA. 24. Department of Medicine (Critical Care and Gastroenterology), McMaster University, Hamilton, ON, Canada.
Abstract
OBJECTIVES: To describe novel guideline development strategies created and implemented as part of the Society of Critical Care Medicine's 2018 clinical practice guidelines for pain, agitation (sedation), delirium, immobility (rehabilitation/mobility), and sleep (disruption) in critically ill adults. DESIGN: We involved critical illness survivors from start to finish, used and expanded upon Grading of Recommendations, Assessment, Development and Evaluation methodology for making recommendations, identified evidence gaps, and developed communication strategies to mitigate challenges. SETTING/ SUBJECTS: Thirty-two experts from five countries, across five topic-specific sections; four methodologists, two medical librarians, four critical illness survivors, and two Society of Critical Care Medicine support staff. INTERVENTIONS: Unique approaches included the following: 1) critical illness survivor involvement to help ensure patient-centered questions and recommendations; 2) qualitative and semiquantitative approaches for developing descriptive statements; 3) operationalizing a three-step approach to generating final recommendations; and 4) systematic identification of evidence gaps. MEASUREMENTS AND MAIN RESULTS: Critical illness survivors contributed to prioritizing topics, questions, and outcomes, evidence interpretation, recommendation formulation, and article review to ensure that their values and preferences were considered in the guidelines. Qualitative and semiquantitative approaches supported formulating descriptive statements using comprehensive literature reviews, summaries, and large-group discussion. Experts (including the methodologists and guideline chairs) developed and refined guideline recommendations through monthly topic-specific section conference calls. Recommendations were precirculated to all members, presented to, and vetted by, most members at a live meeting. Final electronic voting provided links to all forest plots, evidence summaries, and "evidence to decision" frameworks. Written comments during voting captured dissenting views and were integrated into evidence to decision frameworks and the guideline article. Evidence gaps, reflecting clinical uncertainty in the literature, were identified during the evidence to decision process, live meeting, and voting and formally incorporated into all written recommendation rationales. Frequent scheduled "check-ins" mitigated communication gaps. CONCLUSIONS: Our multifaceted, interdisciplinary approach and novel methodologic strategies can help inform the development of future critical care clinical practice guidelines.
OBJECTIVES: To describe novel guideline development strategies created and implemented as part of the Society of Critical Care Medicine's 2018 clinical practice guidelines for pain, agitation (sedation), delirium, immobility (rehabilitation/mobility), and sleep (disruption) in critically ill adults. DESIGN: We involved critical illness survivors from start to finish, used and expanded upon Grading of Recommendations, Assessment, Development and Evaluation methodology for making recommendations, identified evidence gaps, and developed communication strategies to mitigate challenges. SETTING/ SUBJECTS: Thirty-two experts from five countries, across five topic-specific sections; four methodologists, two medical librarians, four critical illness survivors, and two Society of Critical Care Medicine support staff. INTERVENTIONS: Unique approaches included the following: 1) critical illness survivor involvement to help ensure patient-centered questions and recommendations; 2) qualitative and semiquantitative approaches for developing descriptive statements; 3) operationalizing a three-step approach to generating final recommendations; and 4) systematic identification of evidence gaps. MEASUREMENTS AND MAIN RESULTS:Critical illness survivors contributed to prioritizing topics, questions, and outcomes, evidence interpretation, recommendation formulation, and article review to ensure that their values and preferences were considered in the guidelines. Qualitative and semiquantitative approaches supported formulating descriptive statements using comprehensive literature reviews, summaries, and large-group discussion. Experts (including the methodologists and guideline chairs) developed and refined guideline recommendations through monthly topic-specific section conference calls. Recommendations were precirculated to all members, presented to, and vetted by, most members at a live meeting. Final electronic voting provided links to all forest plots, evidence summaries, and "evidence to decision" frameworks. Written comments during voting captured dissenting views and were integrated into evidence to decision frameworks and the guideline article. Evidence gaps, reflecting clinical uncertainty in the literature, were identified during the evidence to decision process, live meeting, and voting and formally incorporated into all written recommendation rationales. Frequent scheduled "check-ins" mitigated communication gaps. CONCLUSIONS: Our multifaceted, interdisciplinary approach and novel methodologic strategies can help inform the development of future critical care clinical practice guidelines.
Authors: Katarzyna Kotfis; Irene van Diem-Zaal; Shawniqua Williams Roberson; Mark van den Boogaard; Yahya Shehabi; E Wesley Ely; Marek Sietnicki Journal: Crit Care Date: 2022-07-05 Impact factor: 19.334
Authors: Benoît Bataille; David Le Moal; Thomas Renault; Pierre Cocquet; Jade de Selle; Stein Silva Journal: J Clin Monit Comput Date: 2021-12-05 Impact factor: 1.977