TY - JOUR
T1 - Methodologic innovation in creating clinical practice guidelines
T2 - Insights from the 2018 Society of Critical Care Medicine pain, agitation/sedation, delirium, immobility, and sleep disruption guideline effort
AU - Devlin, John W.
AU - Skrobik, Yoanna
AU - Rochwerg, Bram
AU - Nunnally, Mark E.
AU - Needham, Dale M.
AU - Gelinas, Celine
AU - Pandharipande, Pratik P.
AU - Slooter, Arjen J.C.
AU - Watson, Paula L.
AU - Weinhouse, Gerald L.
AU - Kho, Michelle E.
AU - Centofanti, John
AU - Price, Carrie
AU - Harmon, Lori
AU - Misak, Cheryl J.
AU - Flood, Pamela D.
AU - Alhazzani, Waleed
N1 - Funding Information:
Dr. Devlin has received research funding from the National Institute of Aging, National Heart, Lung and Blood Institute, and AstraZeneca Pharmaceuticals, is on the editorial board of Critical Care Medicine, and is the president of the American Delirium Society. Dr. Skrobik participates in the American Thoracic Society (ATS) and the American College of Chest Physicians, and she is on the editorial board for Intensive Care Medicine and Chest. Dr. Rochwerg participates as a guideline methodologist for other organizations (i.e., ATS and Canadian Blood Service) in addition to Society of Critical Care Medicine. Dr. Nunnally participates in the Society of Critical Care Anesthesiologists, International Anesthesia Research Society, and American Society of Anesthesiology (ASA). Dr. Needham is a principal investigator on a National Institutes of Health (NIH)-funded, multicentered randomized trial (R01HL132887) evaluating nutrition and exercise in acute respiratory failure and, related to this trial, is currently in receipt of an unrestricted research grant and donated amino acid product from Baxter Healthcare and an equipment loan from Reck Medical Devices to two of the participating study sites, external to his institution. Dr. Pandharipande’s institution received funding from Hospira (research grant to purchase study drug [dexmedetomidine] in collaboration with a NIH-funded RO1 study) and disclosed that he is the past president of the American Delirium Society. Dr. Slooter has disclosed that he is involved in the development of an electroencephalography-based delirium monitor, where any (future) profits from electroencephalography-based delirium monitoring will be used for future scientific research only. Dr. Kho received funding from Restorative Therapies (Baltimore, MD) (loaned two supine cycle ergometers for
Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
KW - Assessment
KW - Clinical practice guidelines; delirium
KW - Development
KW - Evaluation
KW - Grading of Recommendations
KW - intensive care
KW - methods
KW - mobilization
KW - pain
KW - sedation
KW - sleep
UR - http://www.scopus.com/inward/record.url?scp=85056423161&partnerID=8YFLogxK
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U2 - 10.1097/CCM.0000000000003298
DO - 10.1097/CCM.0000000000003298
M3 - Article
C2 - 29985807
AN - SCOPUS:85056423161
SN - 0090-3493
VL - 46
SP - 1457
EP - 1463
JO - Critical care medicine
JF - Critical care medicine
IS - 9
ER -