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Τετάρτη 28 Ιουνίου 2017

Methodology in systematic reviews of goal-directed therapy: improving but not perfect

There has been a recent tsunami of articles on goal-directed (fluid) therapy, haemodynamic optimization and validation of cardiovascular monitoring devices. This has been followed by a wave of systematic reviews, in particular over the last five years, trying to summarize and derive conclusions and recommendations from many of these studies.119 Terminology for systematic reviews and meta-analyses is frequently used incorrectly. A systematic review refers to a rigorous scientific process of reviewing relevant literature whereas meta-analysis refers to a statistical method of pooling data from multiple studies to derive a summary effect estimate. Any well-conducted scientific process needs to comply with quality standards. Likewise, systematic reviews need to meet quality criteria before qualifying for the highest level of evidence (http://ift.tt/17HmMli, accessed May 29, 2017), including a sufficiently detailed published protocol, full search strategy in multiple databases, outcome selection following GRADE20 (http://ift.tt/YgVdNI, accessed May 29, 2017), assessment of risks of bias, assessment of risks of random errors, and reporting results following PRISMA21 and GRADEpro. Producing pooled estimates is always tempting whereas frequently not pooling data because of large heterogeneity might be much wiser. Eventually, only a few systematic reviews qualify for Level 1A evidence.

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