GRADE

Definitie

Hoog

• er is hoge zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• het is zeer onwaarschijnlijk dat de literatuurconclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Redelijk

• er is redelijke zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• het is mogelijk dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Laag

• er is lage zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• er is een reële kans dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Zeer laag

• er is zeer lage zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• de literatuurconclusie is zeer onzeker.

Implicaties van sterke en zwakke aanbevelingen voor verschillende richtlijngebruikers

Sterke aanbeveling

Zwakke (conditionele) aanbeveling

Voor patiënten

De meeste patiënten zouden de aanbevolen interventie of aanpak kiezen en slechts een klein aantal niet.

Een aanzienlijk deel van de patiënten zouden de aanbevolen interventie of aanpak kiezen, maar veel patiënten ook niet.

Voor behandelaars

De meeste patiënten zouden de aanbevolen interventie of aanpak moeten ontvangen.

Er zijn meerdere geschikte interventies of aanpakken. De patiënt moet worden ondersteund bij de keuze voor de interventie of aanpak die het beste aansluit bij zijn of haar waarden en voorkeuren.

Voor beleidsmakers

De aanbevolen interventie of aanpak kan worden gezien als standaardbeleid.

Beleidsbepaling vereist uitvoerige discussie met betrokkenheid van veel stakeholders. Er is een grotere kans op lokale beleidsverschillen.

Database(s): Embase.com, Ovid/Medline

Datum: 8 mei 2024

Periode: vanaf 2000

Talen: geen restrictie

EMBASE

OVID/MEDLINE

Ontdubbeld

SR

123

46

136

RCT

411

145

453

Observationele studies

798

381

888

Totaal

1332

572

589*

No.

Query

Results

#1

'asthma'/exp OR 'bronchus hyperreactivity'/exp OR (((airway OR airflow OR repirator*) NEAR/2 (obstruct* OR occlusion* OR closure)):ti,ab,kw) OR ((bronch* NEAR/2 (hyperreactiv* OR 'hyper reactiv*' OR hyperrespons* OR 'hyper respons*')):ti,ab,kw) OR asthma*:ti,ab,kw OR wheez*:ti,ab,kw OR 'chronic obstructive lung disease'/exp OR ('chronic obstructive' NEAR/2 (lung OR pulmonary OR airway)) OR 'copd':ab,ti,kw OR 'chronic bronchitis':ab,ti,kw OR emphysema:ab,ti,kw OR aecopd:ti,ab,kw OR 'lung disease'/de OR 'autoimmune lung disease'/exp OR 'chronic lung disease'/exp OR 'congenital lung disease'/exp OR 'interstitial lung disease'/exp OR 'interstitial syndrome'/exp OR 'lung calcification'/exp OR 'lung emphysema'/exp OR 'obstructive lung disease'/exp OR 'pulmonary vascular disease'/exp OR (((lung* OR pulmon* OR pneumo* OR pleuropulm* OR bronchopulm* OR cardiopulm*) NEAR/3 (disease* OR disorder*)):ti,ab,kw) OR 'lung fibrosis'/exp OR (((pulmon* OR lung* OR interstitial) NEAR/2 (fibros* OR scleros*)):ti,ab,kw) OR 'pneumosclerosis':ti,ab,kw OR (('high risk' NEAR/3 patient*):ti,ab,kw)

1279996

#2

'postoperative period'/de OR 'postoperative care'/exp OR 'postanesthesia care'/exp OR 'postanesthesia nursing'/exp OR 'postoperative complication'/de OR postsurg*:ti,ab,kw OR 'post surg*':ti,ab,kw OR postoperati*:ti,ab,kw OR 'post operati*':ti,ab,kw OR ((surgery NEAR/3 (associated OR derived OR induced OR related OR after)):ti,ab,kw)

1745558

#3

'intensive care'/de OR 'intensive care unit'/exp OR 'intensive care nursing'/de OR 'recovery room'/exp OR (((intensive OR critical OR medium) NEAR/2 care):ti,ab,kw) OR icu:ti,ab,kw OR (((recovery OR 'post anaesthesia' OR 'post anesthesia' OR postanaesthesia OR postanesthesia OR 'post operative' OR postoperative) NEAR/3 (room* OR unit* OR ward*)):ti,ab,kw) OR pacu:ti,ab,kw OR ((('post anaesthesia' OR 'post anesthesia' OR postanaesthesia OR postanesthesia OR 'post operative' OR postoperative) NEAR/3 monitor*):ti,ab,kw)

613304

#4

'pneumonia'/exp OR pneumoni*:ti,ab,kw OR (((lung OR pulmon*) NEAR/3 inflammat*):ti,ab,kw) OR 'disease exacerbation'/de OR exacerbat*:ti,ab,kw OR 'hypoxemia'/exp OR hypoxemi*:ti,ab,kw OR hypoxaemi*:ti,ab,kw OR hypoxidosis:ti,ab,kw OR anoxemia:ti,ab,kw OR anoxaemia:ti,ab,kw OR anoxia:ti,ab,kw OR hypoxi*:ti,ab,kw OR 'pulmonary complication'/exp OR (((pulmonary OR cardiopulmonary OR cardiorespiratory OR respirat* OR lung*) NEAR/3 complication*):ti,ab,kw) OR 'atelectasis'/exp OR atelectasis:ti,ab,kw OR (((pulmonary OR lung*) NEAR/3 (collaps* OR deflat*)):ti,ab,kw) OR 'respiratory failure'/exp OR (((respirat* OR pulmonary OR cardiopulmonary OR cardiorespiratory OR lung*) NEAR/3 (failure OR deficien* OR disturb* OR insufficien* OR arrest OR collaps*)):ti,ab,kw) OR 'bronchospasm'/exp OR bronchospas*:ti,ab,kw OR bronchiospas*:ti,ab,kw OR bronchismus:ti,ab,kw OR bronchostriction:ti,ab,kw OR (((bronchial OR bronchus OR broncho*) NEAR/3 (constrict* OR spasm* OR spastica)):ti,ab,kw)

1465994

#5

#1 AND #2 AND #3 AND #4 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) NOT (('adolescent'/exp OR 'child'/exp OR adolescent*:ti,ab,kw OR child*:ti,ab,kw OR schoolchild*:ti,ab,kw OR infant*:ti,ab,kw OR girl*:ti,ab,kw OR boy*:ti,ab,kw OR teen:ti,ab,kw OR teens:ti,ab,kw OR teenager*:ti,ab,kw OR youth*:ti,ab,kw OR pediatr*:ti,ab,kw OR paediatr*:ti,ab,kw OR puber*:ti,ab,kw) NOT ('adult'/exp OR 'aged'/exp OR 'middle aged'/exp OR adult*:ti,ab,kw OR man:ti,ab,kw OR men:ti,ab,kw OR woman:ti,ab,kw OR women:ti,ab,kw)) AND [2000-2024]/py

2112

#6

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

1025597

#7

'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random*:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo*:ab,ti

4024922

#8

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

8206230

#9

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

15049948

#10

#5 AND #6 - SR

123

#11

#5 AND #7 NOT #10 - RCT

411

#12

#5 AND (#8 OR #9) NOT (#10 OR #11) - observationeel

798

#13

#10 OR #11 OR #12

1332

#

Searches

Results

1

exp Asthma/ or Bronchial Hyperreactivity/ or ((airway or airflow or repirator*) adj2 (obstruct* or occlusion* or closure)).ti,ab,kf. or (bronch* adj2 (hyperreactiv* or hyper reactiv* or hyperrespons* or hyper respons*)).ti,ab,kf. or asthma*.ti,ab,kf. or wheez*.ti,ab,kf. or exp Pulmonary Disease, Chronic Obstructive/ or ('chronic obstructive' adj2 (lung or pulmonary or airway)).ti,ab,kf. or copd.ti,ab,kf. or 'chronic bronchitis'.ti,ab,kf. or exp Emphysema/ or emphysema.ti,ab,kf. or aecopd.ti,ab,kf. or Lung Diseases/ or exp Cystic Fibrosis/ or exp Lung Diseases, Interstitial/ or exp Lung Diseases, Obstructive/ or ((lung* or pulmon* or pneumo* or pleuropulm* or bronchopulm* or cardiopulm*) adj3 (disease* or disorder*)).ti,ab,kf. or Pulmonary Fibrosis/ or ((pulmon* or lung* or interstitial) adj2 (fibros* or scleros*)).ti,ab,kf. or 'pneumosclerosis'.ti,ab,kf. or ('high risk' adj3 patient*).ti,ab,kf.

735544

2

exp Postoperative Period/ or exp Postoperative Care/ or Postoperative Complications/ or postsurg*.ti,ab,kf. or 'post surg*'.ti,ab,kf. or postoperati*.ti,ab,kf. or 'post operati*'.ti,ab,kf. or (surgery adj3 (associated or derived or induced or related or after)).ti,ab,kf.

1274402

3

Critical Care/ or exp Intensive Care Units/ or exp Critical Care Nursing/ or exp Early Goal-Directed Therapy/ or exp Recovery Room/ or ((intensive or critical or medium) adj2 care).ti,ab,kf. or icu.ti,ab,kf. or ((recovery or 'post anaesthesia' or 'post anesthesia' or postanaesthesia or postanesthesia or 'post operative' or postoperative) adj3 (room* or unit* or ward*)).ti,ab,kf. or pacu.ti,ab,kf. or (('post anaesthesia' or 'post anesthesia' or postanaesthesia or postanesthesia or 'post operative' or postoperative) adj3 monitor*).ti,ab,kf.

331991

4

exp Pneumonia/ or pneumoni*.ti,ab,kf. or ((lung or pulmon*) adj3 inflammat*).ti,ab,kf. or exacerbat*.ti,ab,kf. or Hypoxia/ or exp Hypoxia, Brain/ or hypoxemi*.ti,ab,kf. or hypoxaemi*.ti,ab,kf. or hypoxidosis.ti,ab,kf. or anoxemia.ti,ab,kf. or anoxaemia.ti,ab,kf. or anoxia.ti,ab,kf. or hypoxi*.ti,ab,kf. or ((pulmonary or cardiopulmonary or cardiorespiratory or respirat* or lung*) adj3 complication*).ti,ab,kf. or exp Pulmonary Atelectasis/ or atelectasis.ti,ab,kf. or ((pulmonary or lung*) adj3 (collaps* or deflat*)).ti,ab,kf. or exp Respiratory Insufficiency/ or ((respirat* or pulmonary or cardiopulmonary or cardiorespiratory or lung*) adj3 (failure or deficien* or disturb* or insufficien* or arrest or collaps*)).ti,ab,kf. or exp Bronchial Spasm/ or bronchospas*.ti,ab,kf. or bronchiospas*.ti,ab,kf. or bronchismus.ti,ab,kf. or bronchostriction.ti,ab,kf. or ((bronchial or bronchus or broncho*) adj3 (constrict* or spasm* or spastica)).ti,ab,kf.

1045806

5

(1 and 2 and 3 and 4) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) not ((Adolescent/ or Child/ or Infant/ or adolescen*.ti,ab,kf. or child*.ti,ab,kf. or schoolchild*.ti,ab,kf. or infant*.ti,ab,kf. or girl*.ti,ab,kf. or boy*.ti,ab,kf. or teen.ti,ab,kf. or teens.ti,ab,kf. or teenager*.ti,ab,kf. or youth*.ti,ab,kf. or pediatr*.ti,ab,kf. or paediatr*.ti,ab,kf. or puber*.ti,ab,kf.) not (Adult/ or adult*.ti,ab,kf. or man.ti,ab,kf. or men.ti,ab,kf. or woman.ti,ab,kf. or women.ti,ab,kf.))

942

6

limit 5 to yr="2000 -Current"

787

7

meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf.

744647

8

exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw.

2723144

9

Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies]

4720363

10

Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.))

5684953

11

6 and 7 - SR

46

12

(6 and 8) not 11 - RCT

145

13

(6 and (9 or 10)) not (11 or 12) - observationeel

381

14

11 or 12 or 13

572