Facing a serious problem: how to treat specific critical population without recommendations from current clinical practice guidelines

Abstract Objective: Some special populations are always excluded from Clinical Practice Guidelines (CPGs), the study was attempted to analyze the characteristic and categories of excluded populations from the relevant CPGs from the field of Critical care medicine (CCM).Methods: Electronic databases of PubMed and Scopus were searched from October 9, 2016 to October 9, 2020. The search strategy consisted of key terms related to critical care and guidelines. Each included CPG was examined for full text to identify the randomized controlled trials (RCTs) in the reference. Each included RCT was examined for full text to identify the excluded subjects. Required data from the eligible RCTs and all data were extracted by two reviewers.Results: A total of 33 publications of CPGs were included, consisting of 1134 recommendations including 1231 RCTs. 91.3% of RCTs had exclusion criteria. The exclusion criteria for the top five rankings in the 1231 RCTs were as follows: patients with age <18 years (37.9%), pregnant (29.5%), moribund (19.2%), surgical history (14.8%), renal impairment (14.2%). Twenty topics were finally categorized from these 33 CPGs. The top five rankings of exclusion criteria in these topics included age < 18 years (100%, 20/20), pregnant women (85%, 17/20), moribund (60%, 12/20), surgical history (30%, 6/20) and renal impairment (30%, 6/20).Conclusion: CPGs from the field of critical care medicine (CCM) always exclude some special populations including who are age <18 years, pregnant women, moribund, surgical history, and renal impairment, while these kinds of populations are needed more attention.