Objectives:
To develop evidence-based recommendations for clinicians
caring for adults with acute or acute on chronic liver failure in the
ICU.
Design:
The guideline panel comprised 29 members with expertise in
aspects of care of the critically ill patient with liver failure and/or
methodology. The Society of Critical Care Medicine standard operating
procedures manual and conflict-of-interest policy were followed throughout.
Teleconferences and electronic-based discussion among the panel, as well as
within subgroups, served as an integral part of the guideline development.
Setting:
The panel was divided into nine subgroups: cardiovascular,
hematology, pulmonary, renal, endocrine and nutrition, gastrointestinal,
infection, perioperative, and neurology.
Interventions:
We developed and selected population, intervention,
comparison, and outcomes questions according to importance to patients and
practicing clinicians. For each population, intervention, comparison, and
outcomes question, we conducted a systematic review aiming to identify the best
available evidence, statistically summarized the evidence whenever applicable,
and assessed the quality of evidence using the Grading of Recommendations
Assessment, Development, and Evaluation approach. We used the evidence to
decision framework to facilitate recommendations formulation as strong or
conditional. We followed strict criteria to formulate best practice statements.
Measurements and Main
Results:
In this article, we report 29 recommendations (from 30
population, intervention, comparison, and outcomes questions) on the management
acute or acute on chronic liver failure in the ICU, related to five
groups (cardiovascular, hematology, pulmonary, renal, and endocrine). Overall,
six were strong recommendations, 19 were conditional recommendations, four were
best-practice statements, and in two instances, the panel did not issue a
recommendation due to insufficient evidence.
Conclusions:
Multidisciplinary international experts were able to
formulate evidence-based recommendations for the management acute or acute
on chronic liver failure in the ICU, acknowledging that most
recommendations were based on low-quality indirect evidence.
The exsecutive summary can be found here: https://journals.lww.com/ccmjournal/Fulltext/2020/03000/Guidelines_for_the_Management_of_Adult_Acute_and.17.aspx
The exsecutive summary can be found here: https://journals.lww.com/ccmjournal/Fulltext/2020/03000/Guidelines_for_the_Management_of_Adult_Acute_and.17.aspx
