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The document was reviewed by 10 reviewers nominated by the American Society of Echocardiography (ASE) and the Society of Cardiovascular Anesthesiologists and approved for publication by the governing bodies of these organizations. Recommendations for the use of ultrasound were based on supportive literature (category A) with a level 1 weight of scientific evidence (multiple randomized controlled trials with the aggregated findings supported by meta-analysis). The weight or “level” of evidence was assigned within each category ( Table 1). Original research studies relevant to ultrasound-guided vascular access published in peer-reviewed scientific journals from 1990 to 2011 were reviewed using the Medical Subject Headings terms “ultrasonography,” “catheterization-central venous/adverse effects/methods,” “catheterization-peripheral,” “jugular veins,” “subclavian vein,” “femoral vein,” “artery,” “adult,” “pediatric,” “randomized controlled trials,” and “meta-analysis.” The committee reviewed the scientific evidence for the strength of the recommendation (i.e., risk/benefit ratio) as supportive evidence (category A), suggestive evidence (category B), equivocal evidence (category C), or insufficient evidence (category D). The writing committee conducted a comprehensive search of medical and scientific literature in the English language through the use of PubMed and MEDLINE. The literature either does not meet the criteria for content as defined in the “focus” of the guidelines or does not permit a clear interpretation of findings because of methodologic concerns (e.g., confounding in study design or implementation). The available literature cannot be used to assess the relationships among clinical interventions and clinical outcomes. No identified studies address the specified relationships among interventions and outcomes.Ģ. The lack of scientific evidence in the literature is described by the following conditions:ġ. Level 3: Observational studies report inconsistent findings or do not permit inference of beneficial or harmful relationships.Ĭategory D: insufficient evidence from literature Level 2: There is an insufficient number of studies to conduct meta-analysis, and (1) randomized controlled trials have not found significant differences among groups or conditions, or (2) randomized controlled trials report inconsistent findings. Level 1: Meta-analysis did not find significant differences among groups or conditions. The literature cannot determine whether there are beneficial or harmful relationships among clinical interventions and clinical outcomes. Level 3: The literature contains case reports. Level 2: The literature contains noncomparative observational studies with associative (e.g., relative risk, correlation) or descriptive statistics. Level 1: The literature contains observational comparisons (e.g., cohort and case-control research designs) of two or more clinical interventions or conditions and indicates statistically significant differences between clinical interventions for a specified clinical outcome. Information from observational studies permits inference of beneficial or harmful relationships among clinical interventions and clinical outcomes. Level 3: The literature contains a single randomized controlled trial. Level 2: The literature contains multiple randomized controlled trials, but there is an insufficient number of studies to conduct a viable meta-analysis for the purpose of these guidelines. Level 1: The literature contains multiple randomized controlled trials, and the aggregated findings are supported by meta-analysis. 01) differences between clinical interventions for a specified clinical outcome. Randomized controlled trials report statistically significant ( P <. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiography.
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Source: American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography.