Objective To investigate the effects of noninvasive ventilation for the treatment of acute respiratory failure secondary to severe acute respiratory syndrome ( SARS) . Methods 127 patients with complete information were collected from the database of SARS in Guangdong province, who were all consistent with the ALI/ARDS diagnostic criteria. The patients were divided into three groups depending on ventilation status, ie. a no-ventilation group, a noninvasive ventilation group, and a mechanical ventilation group. The outcome of ventilation treatmentwas followed up.Multi-factor regression analysis was conducted to analyze the relations of ventilation treatment with ARDS and mortality, and factors associated with success of noninvasive ventilation. Results As soon as the patients met the diagnostic criteria of ALI/ARDS, the patients in the noninvasive ventilation group were in more serious condition and had a higher proportion of ARDS compared with the no-ventilation group ( P lt;0. 01) . The patients in the mechanical ventilation group had a higher mortality rate ( P lt;0.01) . 6 and 7 patients in the no-ventilation group had noninvasive ventilation and invasive ventilation thereafter, respectively. 15 patients in the noninvasive group switched to invasive ventilation. Compared with the patients without ventilation ( n =45) , the patients receiving noninvasive ventilation ( n = 61) were in more serious condition and at higher risk of developing ARDS ( P lt;0. 01) , but the mortality was not different between them ( P gt; 0. 05) . The patients who continued to receive noninvasive ventilation ( n = 40) were in more serious condition, and at higher risk of developing ARDS compared with the patients without ventilation ( n = 45) ( P lt; 0. 01) . 15 patients in the noninvasive group who switched to invasive ventilation were older than those patients continuing noninvasive ventilation.Conclusions For SARS patients fulfilling the ALI/ARDS criteria, the patients underwent noninvasive ventilation are more severe, run a higher probability of developing ARDS from ALI. But earlier initiation of noninvasive ventilation has no impact on mortality. The patients who tolerate noninvasive ventilation can avoid intubation, especially for young patients. However, the time and indication of shifting from noninvasive ventilation to invasive ventilation should be emphasized.
ObjectivesTo assess the quality of clinical practice guidelines (CPGs) for diagnosis and management of cough in China, and to provide methodological experiences for updating and developing the evidence-based guideline in this field in future. MethodsWe searched CBM, WanFang Data, VIP and CNKI databases, and Chinese clinical guidelines' website to identify and select CPGs related to cough in China. Four reviewers independently evaluated the quality of eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) Ⅱ instrument. ResultsSix guidelines were included. The mean scores for six AGREE Ⅱ domains were low:scope and purpose 61.1%, stakeholder involvement 26.6%, rigor of development 16.7%, clarity and presentation 58.3%, applicability 11.1%, and editorial independence 0.0%. ConclusionThe quality of guidelines for cough in China is low. More efforts are urgently needed to develop high quality Chinese guidelines using methodologically rigorous development frameworks and strengthen guideline reporting.
ObjectivesTo assess the methodological quality of Chinese clinical practice guidelines (CPGs) for respiratory diseases published in 2017, so as to provide evidence for developing and updating CPGs of this field in the future.MethodsWanFang Data, CNKI, VIP, CBM databases, Medlive and other related websites were electronically searched to collect Chinese CPGs for respiratory diseases published from January 2017 to December 2017. Four reviewers independently evaluated the quality of eligible guidelines by using Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument.ResultsA total of 37 guidelines were included. The mean scores of the six AGREE Ⅱ domains (scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, editorial independence) were 59.3%, 25.1%, 10.8%, 59.1%, 25.8%, and 7.3%, respectively. Only 1 guideline (2.7%) was recommended for clinical use, and 2 guidelines (5.4%) were recommended with modification.ConclusionsThe CPGs for respiratory diseases published in China in 2017 have higher quality than CPGs published prior to 2017, however great discrepancies exist when comparing with international guidelines of average level. More attention should be paid on the rigorousness of methodology and the practicality of content in the future development of CPGs.
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.