Guidelines for medical technology in critical care. Technology Subcommittee of the Working Group on Critical Care, Ontario Ministry of Health.
OBJECTIVE: To examine the current status of technology in critical care medicine and to present guidelines for technologies commonly used in Ontario critical care units. DATA SOURCES: A computerized search of the medical literature, interviews with relevant people and a review of existing guidelines or standards were conducted. STUDY SELECTION: Nonrandomized trials and retrospective reviews were included because of a paucity of prospective randomized controlled trials. DATA EXTRACTION: Technologies were assessed by individual committee members. The validity of the technologies was compared with accepted standards when available. All published clinical data were used to assess efficacy. DATA SYNTHESIS: After review of the data, discussion papers on ventilation, and electrocardiographic, hemodynamic and intracranial pressure monitoring were written by committee members and then reviewed by the subcommittee as a whole. For each technology an attempt was made to match need with the patient classifications of the Working Group on Critical Care. Critical care guidelines were then developed through the use of the nominal group and Delphi consensus-gathering techniques. The guidelines were reviewed by external experts. CONCLUSIONS: These guidelines should help in assessing quality assurance and the resources necessary for critical care. Also, they should enable health care providers and hospital administrators to make better decisions when acquiring critical care technology. Since the guidelines represent the current state of knowledge there must be a continuing assessment of the technology and review of the guidelines.