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 , 鄭勁平 ,  JIANGMei , LIYi-min , ZHENGJin-ping

呼吸疾病國家重點實驗室，廣州醫學院第一附屬醫院廣州呼吸疾病研究所（廣州 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, 鄭勁平, 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.	中華醫學會重癥醫學分會. 呼吸機相關性肺炎預防、診斷和治療指南(2013). 中華內科雜志, 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.	楊克虎, 陳耀龍, 李幼平, 等. 中國能否應對指南挑戰?. 中國循證醫學雜志, 2013, 13(6):621-623.
5.	劉鳴. 臨床實踐指南意義、建立方法和評價. 中國卒中雜志, 2006, 1(1):33-36.
6.	http://www.gradeworkinggroup.org/.
7.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE:從證據到推薦. 中國循證醫學雜志, 2009, 9(3):257-259.
8.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE指南:VI. 證據質量評價——不精確性(隨機誤差). 中國循證醫學雜志, 2011, 11(12):1435-1443.
9.	Guyatt G, Oxman AD, Akl EA, et al. GRADE指南:I. 導論——GRADE證據概要表和結果總結表. 中國循證醫學雜志, 2011, 11(4):437-445.
10.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE指南:II. 構建問題、確定重要結果. 中國循證醫學雜志, 2011, 11(4):446-450.
11.	Balshem H, Helfand M, Schunemann HJ, et al. GRADE 指南:III. 證據質量分級. 中國循證醫學雜志, 2011, 11(4):451-455.
12.	Guyatt GH, Oxman AD, Vist G, et al. GRADE 指南:IV. 證據質量分級——研究的局限性(偏倚風險). 中國循證醫學雜志, 2011, 11(4):456-463.
13.	Guyatt GH, Oxman AD, Montori V, et al. GRADE指南:V. 證據質量評價——發表偏倚. 中國循證醫學雜志, 2011, 11(12):1435-1443.
14.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE 指南:VII. 證據質量評價——不一致性. 中國循證醫學雜志, 2011, 11(12):1444-1451.
15.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE 指南:VIII. 證據質量評價——間接性. 中國循證醫學雜志, 2011, 11(12):1452-1458.
16.	Guyatt GH, Oxman AD, Sultan S, et al. GRADE 指南:IX. 證據質量升級. 中國循證醫學雜志, 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:證據質量和推薦強度分級的共識. 中國循證醫學雜志, 2009, 9(1):8-11.
23.	Schunemann HJ, Oxman AD, Brozek J, et al. 診斷性試驗和策略的證據質量和推薦強度的分級. 中國循證醫學雜志, 2009, 9(5):503-508.
24.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE:在推薦分級中體現對資源利用的考慮. 中國循證醫學雜志, 2009, 9(6):610-613.
25.	Jaeschke R, Guyatt GH, Dellinger P, et al. 意見不一致時的策略:應用GRADE網格對臨床實踐指南達成共識. 中國循證醫學雜志, 2009, 9(7):730-733.
26.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE:什么是"證據質量"?為什么它對臨床醫生重要? 中國循證醫學雜志, 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. 中華醫學會重癥醫學分會. 呼吸機相關性肺炎預防、診斷和治療指南(2013). 中華內科雜志, 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. 楊克虎, 陳耀龍, 李幼平, 等. 中國能否應對指南挑戰?. 中國循證醫學雜志, 2013, 13(6):621-623.
5. 劉鳴. 臨床實踐指南意義、建立方法和評價. 中國卒中雜志, 2006, 1(1):33-36.
6. http://www.gradeworkinggroup.org/.
7. Guyatt GH, Oxman AD, Kunz R, et al. GRADE:從證據到推薦. 中國循證醫學雜志, 2009, 9(3):257-259.
8. Guyatt GH, Oxman AD, Kunz R, et al. GRADE指南:VI. 證據質量評價——不精確性(隨機誤差). 中國循證醫學雜志, 2011, 11(12):1435-1443.
9. Guyatt G, Oxman AD, Akl EA, et al. GRADE指南:I. 導論——GRADE證據概要表和結果總結表. 中國循證醫學雜志, 2011, 11(4):437-445.
10. Guyatt GH, Oxman AD, Kunz R, et al. GRADE指南:II. 構建問題、確定重要結果. 中國循證醫學雜志, 2011, 11(4):446-450.
11. Balshem H, Helfand M, Schunemann HJ, et al. GRADE 指南:III. 證據質量分級. 中國循證醫學雜志, 2011, 11(4):451-455.
12. Guyatt GH, Oxman AD, Vist G, et al. GRADE 指南:IV. 證據質量分級——研究的局限性(偏倚風險). 中國循證醫學雜志, 2011, 11(4):456-463.
13. Guyatt GH, Oxman AD, Montori V, et al. GRADE指南:V. 證據質量評價——發表偏倚. 中國循證醫學雜志, 2011, 11(12):1435-1443.
14. Guyatt GH, Oxman AD, Kunz R, et al. GRADE 指南:VII. 證據質量評價——不一致性. 中國循證醫學雜志, 2011, 11(12):1444-1451.
15. Guyatt GH, Oxman AD, Kunz R, et al. GRADE 指南:VIII. 證據質量評價——間接性. 中國循證醫學雜志, 2011, 11(12):1452-1458.
16. Guyatt GH, Oxman AD, Sultan S, et al. GRADE 指南:IX. 證據質量升級. 中國循證醫學雜志, 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:證據質量和推薦強度分級的共識. 中國循證醫學雜志, 2009, 9(1):8-11.
23. Schunemann HJ, Oxman AD, Brozek J, et al. 診斷性試驗和策略的證據質量和推薦強度的分級. 中國循證醫學雜志, 2009, 9(5):503-508.
24. Guyatt GH, Oxman AD, Kunz R, et al. GRADE:在推薦分級中體現對資源利用的考慮. 中國循證醫學雜志, 2009, 9(6):610-613.
25. Jaeschke R, Guyatt GH, Dellinger P, et al. 意見不一致時的策略:應用GRADE網格對臨床實踐指南達成共識. 中國循證醫學雜志, 2009, 9(7):730-733.
26. Guyatt GH, Oxman AD, Kunz R, et al. GRADE:什么是"證據質量"?為什么它對臨床醫生重要? 中國循證醫學雜志, 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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