A policy for diversity, equity, inclusion and anti‐racism in the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI)

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The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM‐RPG) was to provide evidence‐based clinical guidance about the use of higher versus lower oxygenation targets for adult patients in the intensive care unit (ICU). The guideline panel comprised 27 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. We adhered to the methodology for trustworthy clinical practice guidelines, including the use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and used the Evidence‐to‐Decision framework to generate recommendations. A recently published updated systematic review and meta‐analysis constituted the evidence base. Through teleconferences and web‐based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients' values and preferences, costs and resources, equity, feasibility, acceptability, and research priorities. The updated systematic review and meta‐analysis included data from 17 randomized clinical trials with 10,248 participants. There was little to no difference between the use of higher versus lower oxygenation targets for all outcomes with available data, including all‐cause mortality, serious adverse events, stroke, functional outcomes, cognition, and health‐related quality of life (very low certainty of evidence). The panel felt that values and preferences, costs and resources, and equity favored the use of lower oxygenation targets. The ICM‐RPG panel issued one conditional recommendation against the use of higher oxygenation targets: “We suggest against the routine use of higher oxygenation targets in adult ICU patients (conditional recommendation, very low certainty of evidence). Remark: an oxygenation target of SpO2 88%–92% or PaO2 8 kPa/60 mmHg is relevant and safe for most adult ICU patients.”

Section: Methodsmentioning

confidence: 99%

Section: Guideline Panelmentioning

confidence: 99%

Higher versus lower oxygenation targets in adult ICU patients: A rapid practice guideline

Møller,

Granholm,

Al Duhailib

et al. 2023

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“…The two co-chairs may be appointed by a sponsoring organisation (e.g., a specialty medical society) and they will typically decide on the composition of the guideline panel, which should be diverse and balanced with respect to the intended guideline audience, considering geography (including balance between low-middle and high income settings), career stage, gender, profession and other relevant factors. 8,9 The panel should consist of clinicians; content experts (i.e., researchers involved in previous key studies and trials); methodologists and/or statisticians experienced with systematic reviews, guidelines and meta-analyses; allied health professionals; and-importantly-patients and public representatives 10…”

Section: Guideline Panel and Sponsoring Organisationmentioning

confidence: 99%

“…Typically, guideline panels will be led by two chairs 7 : a clinical chair, that is, a clinical expert with experience within the area of interest and a methods chair, that is, an experienced guideline methodologist with appropriate knowledge about all steps of the guideline process, including GRADE. The two co‐chairs may be appointed by a sponsoring organisation (e.g., a specialty medical society) and they will typically decide on the composition of the guideline panel, which should be diverse and balanced with respect to the intended guideline audience, considering geography (including balance between low‐middle and high income settings), career stage, gender, profession and other relevant factors 8,9 . The panel should consist of clinicians; content experts (i.e., researchers involved in previous key studies and trials); methodologists and/or statisticians experienced with systematic reviews, guidelines and meta‐analyses; allied health professionals; and—importantly—patients and public representatives 10 (Figure 2), to ensure that the resulting guideline has considered the preferences and values of those it will ultimately affect.…”

Section: Guideline Panel and Sponsoring Organisationmentioning

confidence: 99%

GRADE pearls and pitfalls—Part 2: Clinical practice guidelines

Granholm,

Al Duhailib,

Alhazzani

et al. 2024

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BackgroundThe Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is the de facto standard framework for summarising evidence in systematic reviews and developing recommendations in clinical practice guidelines.MethodsWe describe how the GRADE approach is used in clinical practice guidelines, including key points and examples. The intended audience of this overview of GRADE is clinicians and researchers who are, or plan to be, involved in the development or assessment of clinical practice guidelines.ResultsWe cover guideline endorsement and adaptation; guideline panels and sponsors; conflicts of interest; guideline questions and outcome prioritisation; systematic review creation, updating and re‐use; rating the overall certainty of evidence; development of recommendations and implications; and peer review, publication, implementation and updating of guidelines.ConclusionsThis overview aims to help developers, assessors and users of clinical practice guidelines understand how trustworthy, high‐quality guidelines are developed using the GRADE approach.

“…We aimed for diversity in the panel, including gender, age, profession, and geography. 11 A clinical chair (A.S.A.) and a methods chair (M.H.M.)…”

Section: Guideline Panelmentioning

confidence: 99%

New‐onset atrial fibrillation in critically ill adult patients—an SSAI clinical practice guideline

Andreasen

Wetterslev

Sigurdsson

et al. 2023

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BackgroundAcute or new‐onset atrial fibrillation (NOAF) is the most common cardiac arrhythmia in critically ill adult patients, and observational data suggests that NOAF is associated to adverse outcomes.MethodsWe prepared this guideline according to the Grading of Recommendations Assessment, Development and Evaluation methodology. We posed the following clinical questions: (1) what is the better first‐line pharmacological agent for the treatment of NOAF in critically ill adult patients?, (2) should we use direct current (DC) cardioversion in critically ill adult patients with NOAF and hemodynamic instability caused by atrial fibrillation?, (3) should we use anticoagulant therapy in critically ill adult patients with NOAF?, and (4) should critically ill adult patients with NOAF receive follow‐up after discharge from hospital? We assessed patient‐important outcomes, including mortality, thromboembolic events, and adverse events. Patients and relatives were part of the guideline panel.ResultsThe quantity and quality of evidence on the management of NOAF in critically ill adults was very limited, and we did not identify any relevant direct or indirect evidence from randomized clinical trials for the prespecified PICO questions. We were able to propose one weak recommendation against routine use of therapeutic dose anticoagulant therapy, and one best practice statement for routine follow‐up by a cardiologist after hospital discharge. We were not able to propose any recommendations on the better first‐line pharmacological agent or whether to use DC cardioversion in critically ill patients with hemodynamic instability induced by NOAF. An electronic version of this guideline in layered and interactive format is available in MAGIC: https://app.magicapp.org/#/guideline/7197.ConclusionsThe body of evidence on the management of NOAF in critically ill adults is very limited and not informed by direct evidence from randomized clinical trials. Practice variation appears considerable.