目的：为ICU中治疗成人急性肝衰竭（ALF）或慢性急性肝衰竭（ACLF）的临床医生提供循证建议。
方法：指南小组由27名成员组成，他们在肝功能衰竭危重患者的护理或方法方面具有专业知识。我们遵守重症监护医学学会标准操作程序手册和利益冲突政策。小组之间的电话会议和基于电子的讨论，以及在子组中，作为指导方针发展的一个组成部分。
方法：在本指南的第2部分中，小组分为四个亚组：神经病学，围移植,传染病,和胃肠道组。我们开发并选择了人口，干预,比较,和结果（PICO）问题，根据对患者和执业临床医生的重要性。对于每个PICO问题，在适用的情况下,我们进行了系统回顾和荟萃分析.使用建议分级评估来评估证据质量，发展,和评价方法。我们将证据用于决策框架，以促进强有力或有条件的建议制定。我们遵循严格的标准来制定最佳实践声明。
结果：我们报告了关于ICU中ALF和ACLF管理的28条建议（来自31个PICO问题）。总的来说,五是强有力的建议，21是有条件的建议，两个是最佳实践陈述，由于证据不足，我们无法就五个问题提出建议。
结论：多学科，国际专家为ICU中ALF和ACLF患者的管理制定了循证建议，承认大多数建议是基于低质量和间接证据。
To develop evidence-based recommendations for clinicians caring for adults with acute liver failure (ALF) or acute on chronic liver failure (ACLF) in the ICU.
The
guideline panel comprised 27 members with expertise in aspects of care of the critically ill patient with liver failure or methodology. We adhered to the Society of Critical Care Medicine standard operating procedures manual and conflict-of-interest policy. Teleconferences and electronic-based discussion among the panel, as well as within subgroups, served as an integral part of the
guideline development.
In part 2 of this
guideline, the panel was divided into four subgroups: neurology, peri-transplant, infectious diseases, and gastrointestinal groups. We developed and selected Population, Intervention, Comparison, and Outcomes (PICO) questions according to importance to patients and practicing clinicians. For each PICO question, we conducted a systematic review and meta-analysis where applicable. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence to decision framework to facilitate recommendations formulation as strong or conditional. We followed strict criteria to formulate best practice statements.
We report 28 recommendations (from 31 PICO questions) on the management ALF and ACLF in the ICU. Overall, five were strong recommendations, 21 were conditional recommendations, two were best-practice statements, and we were unable to issue a recommendation for five questions due to insufficient evidence.
Multidisciplinary, international experts formulated evidence-based recommendations for the management ALF and ACLF patients in the ICU, acknowledging that most recommendations were based on low quality and indirect evidence.
PDF(Pubmed)