Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

Quality Assessment of Clinical Practice Guidelines for Integrative Medicine in China:A Systematic Review

Objective： To assess the quality of integrative medicine clinical practice guidelines（CPGs） published before 2014. Methods： A systematic search of the scientific literature published before 2014 was conducted to select integrative medicine CPGs. Four major Chinese integrated databases and one guideline database were searched： the Chinese Biomedical Literature Database（CBM）, the China National Knowledge Infrastructure（CNKI）, China Science and Technology Journal Database（VIP）, Wanfang Data, and the China Guideline Clearinghouse（CGC）. Four reviewers independently assessed the quality of the included guidelines using the Appraisal of Guidelines for Research and Evaluation（AGREE） Ⅱ Instrument. Overall consensus among the reviewers was assessed using the intra-class correlation coefficient（ICC）. Results： A total of 41 guidelines published from 2003 to 2014 were included. The overall consensus among the reviewers was good [ICC： 0.928; 95% confidence interval（CI）： 0.920 to 0.935]. The scores on the 6 AGREE domains were： 17% for scope and purpose（range： 6% to 32%）, 11% for stakeholder involvement（range： 0 to 24%）, 10% for rigor of development（range： 3% to 22%）, 39% for clarity and presentation（range： 25% to 64%）, 11% for applicability（range： 4% to 24%）, and 1% for editorial independence（range： 0 to 15%）. Conclusions： The quality of integrative medicine CPGs was low, the development of integrative medicine CPGs should be guided by systematic methodology. More emphasis should be placed on multi-disciplinary guideline development groups, quality of evidence, management of funding and conflicts of interest, and guideline updates in the process of developing integrative medicine CPGs in China.