Intensive care medicine rapid practice guidelines (ICM-RPG): paving the road of the future
Clinical practice guidelines
Evidence to decision
Guidelines in intensive care development and evaluation
Grading of recommendations, assessment, development and evaluation
Intensive care medicine
Rapid practice guidelines
Over the past decade, clinical practice guidelines (CPGs) have undergone extensive and rapid development. The credibility of CPGs is proportional to the methodological rigour, effective management of conflict of interest (COI), incorporation of patients’ values and preferences, and transparency of judgments. With the emergence of the Grading of recommendations, assessment, development and evaluation (GRADE) approach, CPG development has become systematic, transparent, and based on explicit judgments. The GRADE approach is an essential component of trustworthy CPGs. GRADE has been adopted by more than 100 organisations worldwide, including the Cochrane Collaboration, the World Health Organization, UpToDate, and many professional societies within critical care . Intensive care medicine (ICM) now joins this list. Here, we provide an introduction and overview of the new series in ICM rapid practice guidelines (ICM-RPGs).
Most CPGs, including in the field of critical care, are at best updated every 3–5 years . Between updates, new and potentially practice-changing evidence may emerge, but guidelines will not incorporate it until their next iteration, potentially delaying evidence dissemination and implementation in clinical practice. Outdated recommendations may also undermine CPGs’ credibility. It is a priority to speed the integration of new evidence in guidelines.
With the ICM-RPGs, we aim to ensure timely production of trustworthy clinical practice recommendations on topical questions related to critical illness diagnosis and/or management. The ICM-RPGs are intended for clinicians and other healthcare professionals caring for critically ill patients.
The process for developing ICM-RPGs is summarised as follows:
To ensure maximal guideline relevance in clinical practice, the ICM-RPG panel will aim to issue a recommendation whenever possible. Recommendations will be presented as either strong (phrased as “we recommend”) or conditional (also known as weak and phrased as “we suggest”). The strength of recommendation will depend on the certainty of evidence across all outcomes, the balance of benefits and harms, patients’ values and preferences, cost and resource utilisation, feasibility, and acceptability. In the recommendation formulation phase, we will use the Evidence-to-Decision framework to evaluate these factors .
When appropriate, visual decision aids will accompany published ICM-RPGs to facilitate guideline implementation. In addition, the panel will provide suggestions to implement the ICM-RPGs in various contexts (e.g. low–middle-income countries/high-income countries) using existing adaptation frameworks .
ICM is the sponsoring organisation and is responsible for forming and overseeing the ICM-CPR steering committee. The GUIDE Group will support methodological and statistical aspects of the ICM-RPG development. All ICM-RPGs will undergo peer and editorial review through ICM.
The British Medical Journal Rapid Recommendation Group developed a similar process and successfully generated several recommendations on different topics in medicine . They have demonstrated the feasibility of conducting high-quality systematic reviews and trustworthy guidelines within a short period of time.
We hope the ICM-RPGs will hasten the translation of evidence in clinical practice. Stay tuned for the first ICM-RPG addressing the use of neuromuscular blocking agents in moderate–to-severe acute respiratory distress syndrome, planned publication in the near future.
Compliance with ethical standards
Conflicts of interest
WA and EB is the chairs of the GUIDE Group that is supporting this initiative; MHM is a GUIDE Group member. GC has no conflicts related to this topic.
- 2.Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377CrossRefGoogle Scholar
- 9.Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schunemann HJ (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394CrossRefGoogle Scholar
- 10.Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, Treweek S, Mustafa RA, Vandvik PO, Meerpohl J, Guyatt GH, Schunemann HJ, Group GW (2016) GRADE evidence to decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ 353:i2089CrossRefGoogle Scholar
- 11.Schunemann HJ, Wiercioch W, Brozek J, Etxeandia-Ikobaltzeta I, Mustafa RA, Manja V, Brignardello-Petersen R, Neumann I, Falavigna M, Alhazzani W, Santesso N, Zhang Y, Meerpohl JJ, Morgan RL, Rochwerg B, Darzi A, Rojas MX, Carrasco-Labra A, Adi Y, AlRayees Z, Riva J, Bollig C, Moore A, Yepes-Nunez JJ, Cuello C, Waziry R, Akl EA (2017) GRADE evidence to decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol 81:101–110CrossRefGoogle Scholar
- 12.Vandvik PO, Otto CM, Siemieniuk RA, Bagur R, Guyatt GH, Lytvyn L, Whitlock R, Vartdal T, Brieger D, Aertgeerts B, Price S, Foroutan F, Shapiro M, Mertz R, Spencer FA (2016) Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk: a clinical practice guideline. BMJ 354:i5085CrossRefGoogle Scholar