Prospective meta-analysis using individual patient data in intensive care medicine

Abstract

Meta-analysis is a technique for combining evidence from multiple trials. However, meta-analyses of studies with substantial heterogeneity among patients within trials-common in intensive care-can lead to incorrect conclusions if performed using aggregate data. Use of individual patient data (IPD) can avoid this concern, increase the power of a meta-analysis, and is useful for exploring subgroup effects. Barriers exist to IPD meta-analysis, most of which are overcome if clinical trials are designed to prospectively facilitate the incorporation of their results with other trials. We review the features of prospective IPD meta-analysis and identify those of relevance to intensive care research. We identify three clinical questions, which are the subject of recent or planned randomised controlled trials where IPD MA offers advantages over approaches using aggregate data.

Fig. 1

Continuum of surge capacity (reprinted with permission from Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, 2009, by the National Academy of Sciences, Courtesy of the National Academies Press, Washington, DC) [3] Post Anesthesia Care Unit (PACU); Intensive Care Unit (ICU). 1 Unless temporary, requires state empowerment, clinical guidance, and protection for triage decisions and authorization for alternate care sites/techniques. Once situational awareness has been achieved, triage decisions should be as systematic and integrated into institutional process, review and documentation as possible. 2 Institutions consider impact on the community of resource use (consider “greatest good” versus individual patient needs, e.g., conserve resources when possible), but patient-centered decision making is still the focus. 3 Institutions (and providers) should make triage decisions balancing the availability of resources to others and the individual patient’s needs—shift to community—centered decision making