title: Methodology for AACT evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning.
abstract: Intravenous lipid emulsion (ILE) therapy is a novel treatment that was discovered in the last decade. Despite unclear understanding of its mechanisms of action, numerous and diverse publications attested to its clinical use. However, current evidence supporting its use is unclear and recommendations are inconsistent. To assist clinicians in decision-making, the American Academy of Clinical Toxicology created a workgroup composed of international experts from various clinical specialties, which includes representatives of major clinical toxicology associations. Rigorous methodology using the Appraisal of Guidelines for Research and Evaluation or AGREE II instrument was developed to provide a framework for the systematic reviews for this project and to formulate evidence-based recommendations on the use of ILE in poisoning. Systematic reviews on the efficacy of ILE in local anesthetic toxicity and non-local anesthetic poisonings as well as adverse effects of ILE are planned. A comprehensive review of lipid analytical interferences and a survey of ILE costs will be developed. The evidence will be appraised using the GRADE system. A thorough and transparent process for consensus statements will be performed to provide recommendations, using a modified Delphi method with two rounds of voting. This process will allow for the production of useful practice recommendations for this therapy.
authors.affiliation: Department of Emergency Medicine, Medical Toxicology Division, McGill University Health Centre, and Centre Antipoison du Québec , Québec, Québec , Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Gosselin
authors.forename: Martin
authors.initials: M
authors.lastname: Morris
authors.forename: Andrea
authors.initials: A
authors.lastname: Miller-Nesbitt
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Hayes
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
authors.forename: Brian M
authors.initials: BM
authors.lastname: Gilfix
authors.forename: Ami M
authors.initials: AM
authors.lastname: Grunbaum
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Bania
authors.forename: Simon H L
authors.initials: SH
authors.lastname: Thomas
authors.forename: José A
authors.initials: JA
authors.lastname: Morais
authors.forename: Andis
authors.initials: A
authors.lastname: Graudins
authors.forename: Benoit
authors.initials: B
authors.lastname: Bailey
authors.forename: Bruno
authors.initials: B
authors.lastname: Mégarbane
authors.forename: Diane P
authors.initials: DP
authors.lastname: Calello
authors.forename: Michael
authors.initials: M
authors.lastname: Levine
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Stellpflug
authors.forename: Lotte C G
authors.initials: LC
authors.lastname: Hoegberg
authors.forename: Ryan
authors.initials: R
authors.lastname: Chuang
authors.forename: Christine
authors.initials: C
authors.lastname: Stork
authors.forename: Ashish
authors.initials: A
authors.lastname: Bhalla
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Rollins
authors.forename: Valéry
authors.initials: V
authors.lastname: Lavergne
mesh_terms: D000779:Anesthetics, Local / Q000506:poisoning*; D000931:Antidotes / Q000627:therapeutic use*; D032921:Consensus; D003697:Delphi Technique; D019317:Evidence-Based Medicine / Q000592:standards*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006801:Humans; D011041:Poisoning / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000931:Antidotes; D005217:Fat Emulsions, Intravenous
keywords: Adverse effect;; Efficacy; Fat emulsion; Intravenous lipid emulsion; Lipid interference; Lipid resuscitation; Recommendation