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      Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

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          Abstract

          Purpose

          To develop evidence-based clinical practice recommendations regarding transfusion practices and transfusion in bleeding critically ill adults.

          Methods

          A taskforce involving 15 international experts and 2 methodologists used the GRADE approach to guideline development. The taskforce addressed three main topics: transfusion support in massively and non-massively bleeding critically ill patients (transfusion ratios, blood products, and point of care testing) and the use of tranexamic acid. The panel developed and answered structured guideline questions using population, intervention, comparison, and outcomes (PICO) format.

          Results

          The taskforce generated 26 clinical practice recommendations (2 strong recommendations, 13 conditional recommendations, 11 no recommendation), and identified 10 PICOs with insufficient evidence to make a recommendation.

          Conclusions

          This clinical practice guideline provides evidence-based recommendations for the management of massively and non-massively bleeding critically ill adult patients and identifies areas where further research is needed.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00134-021-06531-x.

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          Most cited references120

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          Rayyan—a web and mobile app for systematic reviews

          Background Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature. Results Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
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            GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

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              Cochrane Handbook for Systematic Reviews of Interventions

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                Author and article information

                Contributors
                a.p.vlaar@amsterdamumc.nl
                Journal
                Intensive Care Med
                Intensive Care Med
                Intensive Care Medicine
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0342-4642
                1432-1238
                22 October 2021
                22 October 2021
                : 1-25
                Affiliations
                [1 ]GRID grid.509540.d, ISNI 0000 0004 6880 3010, Department of Intensive Care Medicine, , Amsterdam UMC, Location AMC, ; Room, C3-430, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
                [2 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Medicine, , McMaster University, ; Hamilton, Canada
                [3 ]GRID grid.416721.7, ISNI 0000 0001 0742 7355, The Guidelines in Intensive Care Development and Evaluation (GUIDE) Group, , He Research Institute St. Joseph’s Healthcare Hamilton, ; Hamilton, Canada
                [4 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Health Research Methods, Evidence, and Impact, , McMaster University, ; Hamilton, Canada
                [5 ]GRID grid.509540.d, ISNI 0000 0004 6880 3010, Department of Anaesthesiology, , Amsterdam UMC, Location AMC, ; Amsterdam, The Netherlands
                [6 ]GRID grid.414603.4, Department of Anaesthesiology and Intensive Care Medicine, , Fondazione Policlinico Universitario A.Gemelli IRCCS, ; Rome, Italy
                [7 ]GRID grid.8142.f, ISNI 0000 0001 0941 3192, Istituto di Anaesthesiology e Rianimazione Università Cattolica del Sacro Cuore, ; Rome, Italy
                [8 ]Department of Intensive Care Medicine, Centre Hospitalier Régional et Universitaire de Brest, site La Cavale Blanche, Université de Bretagne Occidentale, Brest, France
                [9 ]Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud (HUPS), Le Kremlin-Bicêtre, France
                [10 ]GRID grid.509540.d, ISNI 0000 0004 6880 3010, Laboratory of Experimental Intensive Care and Anesthesiology, , Amsterdam University Medical Center, ; Amsterdam, The Netherlands
                [11 ]GRID grid.440209.b, ISNI 0000 0004 0501 8269, OLVG Hospital, ; Amsterdam, The Netherlands
                [12 ]GRID grid.9970.7, ISNI 0000 0001 1941 5140, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, , Kepler University, ; Linz, Austria
                [13 ]GRID grid.9918.9, ISNI 0000 0004 1936 8411, NIHR Leicester Biomedical Research Centre–Cardiovascular, Department of Cardiovascular Sciences, College of Life Sciences, , University of Leicester, ; Leicester, UK
                [14 ]GRID grid.413548.f, ISNI 0000 0004 0571 546X, Department of Anesthesiology, Intensive Care and Perioperative Medicine, , Hamad Medical Corporation, ; Doha, Qatar
                [15 ]GRID grid.266832.b, ISNI 0000 0001 2188 8502, Division of Pulmonary, Critical Care, and Sleep Medicine, , University of New Mexico School of Medicine, ; Albuquerque, USA
                [16 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department of Anaesthesiology and Intensive Care Medicine, , AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, ; Salzburg, Austria
                [17 ]GRID grid.420022.6, ISNI 0000 0001 0723 5126, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, , AUVA Trauma Research Centre, ; Vienna, Austria
                [18 ]GRID grid.420545.2, Thrombosis and Haemophilia Centre, , Guys & St Thomas’ NHS Foundation Trust, ; London, UK
                [19 ]Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Centre-IRCCS, Rozzano, MI Italy
                [20 ]GRID grid.452490.e, Humanitas University, ; via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
                [21 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Division of Gastroenterology, , McMaster University, ; Hamilton, ON Canada
                Author information
                http://orcid.org/0000-0002-3453-7186
                Article
                6531
                10.1007/s00134-021-06531-x
                8532090
                34677620
                c10d50b2-671a-4369-ae4c-e7297c53d865
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 13 July 2021
                : 4 September 2021
                Categories
                Guidelines

                Emergency medicine & Trauma
                transfusion,coagulopathy,critically ill,guideline,intensive care,plasma,platelets,red blood cells,point of care,tranexamic acid,bleeding

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