Application of GRADE in Development of Evidence-based Clinical Practice Guidelines for the Diagnosis, Prevention and Treatment of Ventilator-associated Pneumonia_Chinese Journal of Evidence-Based Medicine

Authors：

 江梅 , 黎毅敏 , 郑劲平 ,  JIANGMei , LIYi-min , ZHENGJin-ping

呼吸疾病国家重点实验室，广州医学院第一附属医院广州呼吸疾病研究所（广州 510120）;
State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China;

Corresponding author：

江梅, Email: jiangmei927@163.com; JIANGMei, Email: jiangmei927@163.com

Keywords：

Evidence-based clinical practice guideline; Ventilator-associated pneumonia; Guideline development; Methodology; GRADE

DOI：

10.7507/1672-2531.20140148

Video：

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This article introduces development methods and notices about evidence-based clinical practice guidelines of ventilator-associated pneumonia (VAP) and discuss the similarities and differences between GRADE system and the methodological studies of other clinical guidelines, focusing on the analysis of literature retrieval, quality of evidence, formation of recommendation strength, and detailed measures on how to ensure correct understanding and rationally using the GRADE system. Applying the GRADE system to develop evidence-based clinical practice guidelines of VAP could clearly present the quality of evidence and make recommendations.

Citation： 江梅, 黎毅敏, 郑劲平, JIANGMei, LIYi-min, ZHENGJin-ping. Application of GRADE in Development of Evidence-based Clinical Practice Guidelines for the Diagnosis, Prevention and Treatment of Ventilator-associated Pneumonia. Chinese Journal of Evidence-Based Medicine, 2014, 14(7): 897-900. doi: 10.7507/1672-2531.20140148 Copy

1.	中华医学会重症医学分会. 呼吸机相关性肺炎预防、诊断和治疗指南(2013). 中华内科杂志, 2013, 52(6):524-543.
2.	Davis KA. Ventilator-associated pneumonia:a review. J Intensive Care Med, 2006, 21(4):211-226.
3.	Joseph NM, Sistla S, Dutta TK, et al. Ventilator-associated pneumonia:a review. Eur J Intern Med, 2010, 21(5):360-368.
4.	杨克虎, 陈耀龙, 李幼平, 等. 中国能否应对指南挑战?. 中国循证医学杂志, 2013, 13(6):621-623.
5.	刘鸣. 临床实践指南意义、建立方法和评价. 中国卒中杂志, 2006, 1(1):33-36.
6.	http://www.gradeworkinggroup.org/.
7.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE:从证据到推荐. 中国循证医学杂志, 2009, 9(3):257-259.
8.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE指南:VI. 证据质量评价——不精确性(随机误差). 中国循证医学杂志, 2011, 11(12):1435-1443.
9.	Guyatt G, Oxman AD, Akl EA, et al. GRADE指南:I. 导论——GRADE证据概要表和结果总结表. 中国循证医学杂志, 2011, 11(4):437-445.
10.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE指南:II. 构建问题、确定重要结果. 中国循证医学杂志, 2011, 11(4):446-450.
11.	Balshem H, Helfand M, Schunemann HJ, et al. GRADE 指南:III. 证据质量分级. 中国循证医学杂志, 2011, 11(4):451-455.
12.	Guyatt GH, Oxman AD, Vist G, et al. GRADE 指南:IV. 证据质量分级——研究的局限性(偏倚风险). 中国循证医学杂志, 2011, 11(4):456-463.
13.	Guyatt GH, Oxman AD, Montori V, et al. GRADE指南:V. 证据质量评价——发表偏倚. 中国循证医学杂志, 2011, 11(12):1435-1443.
14.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE 指南:VII. 证据质量评价——不一致性. 中国循证医学杂志, 2011, 11(12):1444-1451.
15.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE 指南:VIII. 证据质量评价——间接性. 中国循证医学杂志, 2011, 11(12):1452-1458.
16.	Guyatt GH, Oxman AD, Sultan S, et al. GRADE 指南:IX. 证据质量升级. 中国循证医学杂志, 2011, 11(12):1459-1463.
17.	Brunetti M, Shemilt I, Pregno S, et al. GRADE guidelines:10. Considering resource use and rating the quality of economic evidence. J Clin Epidemiol, 2013, 66(1):140-150.
18.	Guyatt G, Oxman AD, Sultan S, et al. GRADE guidelines:11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol, 2013, 66(2):151-157.
19.	Guyatt GH, Oxman AD, Santesso N, et al. GRADE guidelines:12. Preparing Summary of Findings tables-binary outcomes. J Clin Epidemiol, 2013, 66(2):158-172.
20.	Guyatt GH, Thorlund K, Oxman AD, et al. GRADE guidelines:13. Preparing Summary of Findings tables and evidence profiles-continuous outcomes. J Clin Epidemiol, 2013, 66(2):173-183.
21.	Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines:15. Going from evidence to recommendations:the significance and presentation of recommendations. J Clin Epidemiol, 2013, 66(7):726-735.
22.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE:证据质量和推荐强度分级的共识. 中国循证医学杂志, 2009, 9(1):8-11.
23.	Schunemann HJ, Oxman AD, Brozek J, et al. 诊断性试验和策略的证据质量和推荐强度的分级. 中国循证医学杂志, 2009, 9(5):503-508.
24.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE:在推荐分级中体现对资源利用的考虑. 中国循证医学杂志, 2009, 9(6):610-613.
25.	Jaeschke R, Guyatt GH, Dellinger P, et al. 意见不一致时的策略:应用GRADE网格对临床实践指南达成共识. 中国循证医学杂志, 2009, 9(7):730-733.
26.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE:什么是"证据质量"?为什么它对临床医生重要? 中国循证医学杂志, 2009, 9(2):133-137.
27.	Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012. Crit Care Med, 2013, 41(2):580-637.
28.	Guyatt GH, Norris SL, Schulman S, et al. Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines:Antithrombotic Therapy and Prevention of Thrombosis, 9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 suppl):53S-70S.

1. 中华医学会重症医学分会. 呼吸机相关性肺炎预防、诊断和治疗指南(2013). 中华内科杂志, 2013, 52(6):524-543.
2. Davis KA. Ventilator-associated pneumonia:a review. J Intensive Care Med, 2006, 21(4):211-226.
3. Joseph NM, Sistla S, Dutta TK, et al. Ventilator-associated pneumonia:a review. Eur J Intern Med, 2010, 21(5):360-368.
4. 杨克虎, 陈耀龙, 李幼平, 等. 中国能否应对指南挑战?. 中国循证医学杂志, 2013, 13(6):621-623.
5. 刘鸣. 临床实践指南意义、建立方法和评价. 中国卒中杂志, 2006, 1(1):33-36.
6. http://www.gradeworkinggroup.org/.
7. Guyatt GH, Oxman AD, Kunz R, et al. GRADE:从证据到推荐. 中国循证医学杂志, 2009, 9(3):257-259.
8. Guyatt GH, Oxman AD, Kunz R, et al. GRADE指南:VI. 证据质量评价——不精确性(随机误差). 中国循证医学杂志, 2011, 11(12):1435-1443.
9. Guyatt G, Oxman AD, Akl EA, et al. GRADE指南:I. 导论——GRADE证据概要表和结果总结表. 中国循证医学杂志, 2011, 11(4):437-445.
10. Guyatt GH, Oxman AD, Kunz R, et al. GRADE指南:II. 构建问题、确定重要结果. 中国循证医学杂志, 2011, 11(4):446-450.
11. Balshem H, Helfand M, Schunemann HJ, et al. GRADE 指南:III. 证据质量分级. 中国循证医学杂志, 2011, 11(4):451-455.
12. Guyatt GH, Oxman AD, Vist G, et al. GRADE 指南:IV. 证据质量分级——研究的局限性(偏倚风险). 中国循证医学杂志, 2011, 11(4):456-463.
13. Guyatt GH, Oxman AD, Montori V, et al. GRADE指南:V. 证据质量评价——发表偏倚. 中国循证医学杂志, 2011, 11(12):1435-1443.
14. Guyatt GH, Oxman AD, Kunz R, et al. GRADE 指南:VII. 证据质量评价——不一致性. 中国循证医学杂志, 2011, 11(12):1444-1451.
15. Guyatt GH, Oxman AD, Kunz R, et al. GRADE 指南:VIII. 证据质量评价——间接性. 中国循证医学杂志, 2011, 11(12):1452-1458.
16. Guyatt GH, Oxman AD, Sultan S, et al. GRADE 指南:IX. 证据质量升级. 中国循证医学杂志, 2011, 11(12):1459-1463.
17. Brunetti M, Shemilt I, Pregno S, et al. GRADE guidelines:10. Considering resource use and rating the quality of economic evidence. J Clin Epidemiol, 2013, 66(1):140-150.
18. Guyatt G, Oxman AD, Sultan S, et al. GRADE guidelines:11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol, 2013, 66(2):151-157.
19. Guyatt GH, Oxman AD, Santesso N, et al. GRADE guidelines:12. Preparing Summary of Findings tables-binary outcomes. J Clin Epidemiol, 2013, 66(2):158-172.
20. Guyatt GH, Thorlund K, Oxman AD, et al. GRADE guidelines:13. Preparing Summary of Findings tables and evidence profiles-continuous outcomes. J Clin Epidemiol, 2013, 66(2):173-183.
21. Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines:15. Going from evidence to recommendations:the significance and presentation of recommendations. J Clin Epidemiol, 2013, 66(7):726-735.
22. Guyatt GH, Oxman AD, Vist GE, et al. GRADE:证据质量和推荐强度分级的共识. 中国循证医学杂志, 2009, 9(1):8-11.
23. Schunemann HJ, Oxman AD, Brozek J, et al. 诊断性试验和策略的证据质量和推荐强度的分级. 中国循证医学杂志, 2009, 9(5):503-508.
24. Guyatt GH, Oxman AD, Kunz R, et al. GRADE:在推荐分级中体现对资源利用的考虑. 中国循证医学杂志, 2009, 9(6):610-613.
25. Jaeschke R, Guyatt GH, Dellinger P, et al. 意见不一致时的策略:应用GRADE网格对临床实践指南达成共识. 中国循证医学杂志, 2009, 9(7):730-733.
26. Guyatt GH, Oxman AD, Kunz R, et al. GRADE:什么是"证据质量"?为什么它对临床医生重要? 中国循证医学杂志, 2009, 9(2):133-137.
27. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012. Crit Care Med, 2013, 41(2):580-637.
28. Guyatt GH, Norris SL, Schulman S, et al. Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines:Antithrombotic Therapy and Prevention of Thrombosis, 9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 suppl):53S-70S.

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