Implementatie van evidence-based medicine in de dagelijkse praktijk: Een literatuurvoorbeeld over longbeschermende beademingsstrategieën

Abstract

By the use of a PICO example concerning lung protective ventilation strategies, we discuss a number of barriers for implementation of evidence in clinical practice. A high level of evidence in the hierarchy of evidence based medicine (EBM) does not always directly imply quality or applicability of study results in the individual patient. Applying new findings from literature in clinical practice is therefore not always the case, even with evidence that appears of high quality at first glance. Various aspects are of influence here. First of all there are environmental and doctor-related factors that affect implementation. However, more importantly, determinants related to the evidence itself affect this process, such as the internal validity, the relevance and the external validity of a study. Furthermore, one should also be aware that, when interpreting study results, significant findings can be the result of pure chance. As for the paediatric field there is often a shortage of reliable prospective research. For many cases the only evidence available are studies performed in adults. One should however be cautious in directly translating results from adult to paediatric practice.