International alliance and AGREE-ment of 71 clinical practice guidelines on the management of critical care patients with COVID-19: a living systematic review

Yasser S Amer; Maher A Titi; Mohammad W Godah; Hayfaa A Wahabi; Layal Hneiny; Manal Mohamed Abouelkheir; Muddathir H Hamad; Ghada Metwally ElGohary; Mohamed Ben Hamouda; Hella Ouertatani; Pamela Velasquez-Salazar; Jorge Acosta-Reyes; Samia M Alhabib; Samia Ahmed Esmaeil; Zbys Fedorowicz; Ailing Zhang; Zhe Chen; Sarah Jayne Liptrott; Niccolò Frungillo; Amr A Jamal; Sami A Almustanyir; Newman Ugochukwu Dieyi; John Powell; Katrina J Hon; Rasmieh Alzeidan; Majduldeen Azzo; Sara Zambrano-Rico; Paulina Ramirez-Jaramillo; Ivan D Florez

doi:10.1016/j.jclinepi.2021.11.010

International alliance and AGREE-ment of 71 clinical practice guidelines on the management of critical care patients with COVID-19: a living systematic review

J Clin Epidemiol. 2022 Feb:142:333-370. doi: 10.1016/j.jclinepi.2021.11.010. Epub 2021 Nov 14.

Authors

Yasser S Amer¹, Maher A Titi², Mohammad W Godah³, Hayfaa A Wahabi⁴, Layal Hneiny⁵, Manal Mohamed Abouelkheir⁶, Muddathir H Hamad⁷, Ghada Metwally ElGohary⁸, Mohamed Ben Hamouda⁹, Hella Ouertatani¹⁰, Pamela Velasquez-Salazar¹¹, Jorge Acosta-Reyes¹², Samia M Alhabib¹³, Samia Ahmed Esmaeil¹⁴, Zbys Fedorowicz¹⁵, Ailing Zhang¹⁶, Zhe Chen¹⁶, Sarah Jayne Liptrott¹⁷, Niccolò Frungillo¹⁸, Amr A Jamal⁴, Sami A Almustanyir¹⁹, Newman Ugochukwu Dieyi²⁰, John Powell²¹, Katrina J Hon²², Rasmieh Alzeidan²³, Majduldeen Azzo²⁴, Sara Zambrano-Rico²⁵, Paulina Ramirez-Jaramillo²⁵, Ivan D Florez²⁶

Affiliations

¹ Pediatrics Department and Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia; Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia; Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt.
² Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia; Patient Safety Unit, Quality Management Department King Saud University Medical City, Riyadh, Saudi Arabia.
³ Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
⁴ Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia; Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁵ Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon.
⁶ Department of Clinical Pharmacy, College of Pharmacy, Misr International University, Cairo, Egypt.
⁷ Division of Neurology, Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
⁸ Internal Medicine and Clinical Hematology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; University Oncology Center, University Medical City, King Saud University, Riyadh, Saudi Arabia.
⁹ Clinical Practice Guidelines Unit, INEAS l instance Nationale de l'évaluation et de l'accréditation en santé 7 Rue Ahmed Rami le belvedere 1001 Tunis-TUNISIA.
¹⁰ Clinical Pathways Unit, National Authority for Assessment and Accreditation in Healthcare (INEAS), Tunis, Tunisia.
¹¹ Unidad de Evidencia y Deliberación para la toma de Decisiones (UNED), Faculty of Medicine, University of Antioquia, Medellín, Colombia.
¹² Department of Public Health, Universidad del Norte, Barranquilla, Colombia.
¹³ National Center for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia; King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
¹⁴ Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.
¹⁵ Veritas Health Sciences Consultancy Ltd., Huntingdon, United Kingdom.
¹⁶ First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
¹⁷ Ente Ospedaliero Cantonale, via Gallino 12, 6500 Bellinzona, Switzerland.. Electronic address: [email protected].
¹⁸ Oncology Unit, ASST Fatebenefratelli-Sacco, PO Fateberefratelli, Piazza Principessa Clotilde 3, 20121, Milan, Italy.
¹⁹ Ministry of Health, Riyadh, Saudi Arabia.
²⁰ Division of Community Health and Humanities, Memorial University, St. John's Newfoundland and Labrador, Canada.
²¹ National Institute for Health and Care Excellence, London, UK; Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK.
²² Division of Community Health and Humanities, Memorial University, St. John's Newfoundland and Labrador, Canada; Neuroscience, Mind, Brain, and Behavior, Harvard University, MA, USA.
²³ Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
²⁴ Pediatrics Emergency Department, The International Medical Center, Hail Street, 21451, Jeddah, Saudi Arabia.
²⁵ CES University, Medellín Colombia.
²⁶ Department of Pediatrics, University of Antioquia, Medellin, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Canada. Electronic address: [email protected].

Abstract

Objective: We aimed to systematically identify and critically assess the clinical practice guidelines (CPGs) for the management of critically ill patients with COVID-19 with the AGREE II instrument.

Study design and setting: We searched Medline, CINAHL, EMBASE, CNKI, CBM, WanFang, and grey literature from November 2019 - November 2020. We did not apply language restrictions. One reviewer independently screened the retrieved titles and abstracts, and a second reviewer confirmed the decisions. Full texts were assessed independently and in duplicate. Disagreements were resolved by consensus. We included any guideline that provided recommendations on the management of critically ill patients with COVID-19. Data extraction was performed independently and in duplicate by two reviewers. We descriptively summarized CPGs characteristics. We assessed the quality with the AGREE II instrument and we summarized relevant therapeutic interventions.

Results: We retrieved 3,907 records and 71 CPGs were included. Means (Standard Deviations) of the scores for the 6 domains of the AGREE II instrument were 65%(SD19.56%), 39%(SD19.64%), 27%(SD19.48%), 70%(SD15.74%), 26%(SD18.49%), 42%(SD34.91) for the scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence domains, respectively. Most of the CPGs showed a low overall quality (less than 40%).

Conclusion: Future CPGs for COVID-19 need to rely, for their development, on standard evidence-based methods and tools.

Keywords: AGREE II tool; COVID-19; guidelines; intensive care; quality; rapid guidelines.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

COVID-19 / therapy*
Consensus
Critical Care / standards*
Databases, Factual
Evidence-Based Medicine / standards*
Humans
Internationality
Practice Guidelines as Topic