Li Hong-Yan, Wang Hai-Shan, Wang Ying-Lin, Wang Jing, Huo Xue-Chen, Zhao Quan
Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China.
Department of Intensive Care Unit, Yantai YEDA Hospital, Yantai, China.
Front Pharmacol. 2022 May 20;13:903378. doi: 10.3389/fphar.2022.903378. eCollection 2022.
To assess the quality of clinical practice guidelines (CPGs) related to drug therapy for prevention and control of ventilator-associated pneumonia (VAP) and compare the differences and similarities between recommendations. Electronic databases (including PubMed, Cochrane library, Embase, Web of Science), guideline development organizations, and professional societies were searched to identify CPGs for VAP from 20 January 2012 to 20 January 2022. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. The recommendations on drug therapy for prevention and treatment for each guideline were extracted, and then a descriptive synthesis was performed to analyze the scope/topic, and consistency of the recommendations. Thirteen CPGs were included. The median score and interquartile range (IQR) in each domain are shown below: scope and purpose 72.22% (63.89%,83.33%); stakeholder involvement 44.44% (38.89%,52.78%); rigor of development 43.75% (31.25%,57.29%); clarity and presentation 94.44% (77.78%,94.44%); applicability 20.83 (8.34%,33.34%) and editorial independence 50% (33.33%,66.67%). We extracted 21 recommendations on drug therapy for prevention of VAP and 51 recommendations on drugs used for treatment. Some controversies remained among the included guidelines. There is considerable variability in the development processes and reporting of VAP guidelines. Despite many similarities, the recommendations still had some inconsistencies in the details. For the prevention and treatment of VAP, local microbial epidemiology and antibiotic sensitivity must be considered, and recommendations should be regularly revised as new evidence emerges.
评估与预防和控制呼吸机相关性肺炎（VAP）药物治疗相关的临床实践指南（CPG）质量，并比较各指南建议之间的异同。检索电子数据库（包括PubMed、Cochrane图书馆、Embase、Web of Science）、指南制定组织和专业学会，以识别2012年1月20日至2022年1月20日期间关于VAP的CPG。使用指南研究与评价（AGREE）II工具评估指南质量。提取每个指南中关于预防和治疗药物治疗的建议，然后进行描述性综合分析，以分析建议的范围/主题和一致性。纳入了13项CPG。各领域的中位数得分和四分位数间距（IQR）如下所示：范围和目的72.22%（63.89%，83.33%）；利益相关者参与度44.44%（38.89%，52.78%）；制定的严谨性43.75%（31.25%，57.29%）；清晰度和呈现方式94.44%（77.78%，94.44%）；适用性20.83（8.34%，33.34%）以及编辑独立性50%（33.33%，66.67%）。我们提取了21条关于预防VAP药物治疗的建议和51条关于治疗用药的建议。纳入的指南之间仍存在一些争议。VAP指南的制定过程和报告存在很大差异。尽管有许多相似之处，但建议在细节上仍存在一些不一致之处。对于VAP的预防和治疗，必须考虑当地的微生物流行病学和抗生素敏感性，并且应随着新证据的出现定期修订建议。
