Electronic Supplementary Material
Methods
Search strategy
We conducted a comprehensive search for all publications of prospective RCTs in adult
patients focusing on the impact of monitoring systems in critically ill patients and in
perioperative patients undergoing major procedures. A highly-sensitive search strategy for
RCTs in the Cochrane Central Register of Controlled Trials (CENTRAL) and in MedLine
using the PubMed interface up to June 2006 was carried out using the approach shown in the
electronic supplement Table 1. We did not apply any restrictions to the search. Eligibility
assessment and data abstraction were performed independently in an unblinded standardized
manner by 2 reviewers (G.A.O and R.L.C). Interrater reliability between the abstractors for
the RCTs selected was evaluated using the κ statistic. Discrepancies about classification and
outcomes evaluation were resolved by consensus among the three authors.
A study was selected when it compared a monitored group of patients with a nonmonitored control group or when the health-care team was unaware of monitoring
measurements and so was unable to use them to guide therapy. In hemodynamic studies,
patients undergoing conventional central venous pressure (CVP) monitoring were accepted as
a control group. Likewise, in studies on oxygen delivery (DO2) and oxygen consumption
(VO2) monitoring, a control group conventionally managed using PAC monitoring was
accepted when the treating physicians were blinded to the DO2/VO2 monitoring variables or
when these were not used as goals of resuscitation. We defined outcome in general, including
morbidity and mortality, optimization of therapeutic strategies, complications, costs, and
quality of life.
We do not include repeated diagnostic tests (like chest X rays) and blood laboratory
tests. We excluded articles that did not focus on monitoring, animal and laboratory studies,
non-randomized trials, reviews, letters, meta-analyses, guidelines or commentaries, trials
comparing monitoring methods without a non-monitored control group, trials evaluating the
impact of medicaments or therapies on measurements obtained by a monitoring system, and
studies conducted in the pediatric population.
The selected studies were separated into those evaluating hemodynamic (or tissue
perfusion), respiratory, neurological, or metabolic variables and, according to the results
obtained for each one of their outcome objectives, they were classified as positive, neutral, or
detrimental. Additionally, we classified studies evaluating mortality as primary or secondary
outcome studies.
ESM Table 1. Search strategy for retrieval of reports of randomized controlled trials from MedLine through the PubMed interface
#01
#02
#03
#04
#05
#06
#07
#08
#09
#10
#11
#12
#13
#14
#15
#16
#17
#18
#19
#20
"oximetry"[MeSH Terms] OR oximetry[Text Word]
capnography[Text Word]) OR (end[All Fields] AND tidal[All Fields] AND ("carbon dioxide"[MeSH Terms] OR carbon dioxide[Text Word])
AND monitoring[All Fields])
(("respiratory mechanics"[MeSH Terms] OR respiratory mechanics[Text Word]) AND monitoring[All Fields]
("respiratory dead space"[MeSH Terms] OR respiratory dead space[Text Word])
(("lung compliance"[MeSH Terms] OR lung compliance[Text Word]) AND monitoring[All Fields])
(("exhalation"[TIAB] NOT Medline[SB]) OR "exhalation"[MeSH Terms] OR expiratory[Text Word]) AND plateau[All Fields] AND
("pressure"[MeSH Terms] OR pressure[Text Word])) OR (airway[All Fields] AND ("pressure"[MeSH Terms] OR pressure[Text Word]) AND
monitoring[All Fields])
"intracranial pressure"[MeSH Terms] OR Intracranial pressure[Text Word]
"extravascular lung water"[MeSH Terms] OR extravascular lung water[Text Word]
"ultrasonography"[Subheading] OR "ultrasonography"[MeSH Terms] OR ultrasonography[Text Word]
"transcranial doppler ultrasonography"[Text Word] OR "ultrasonography, doppler, transcranial"[MeSH Terms] OR Doppler transcranial
ultrasonography[Text Word]
("electroencephalography"[TIAB] NOT Medline[SB]) OR "electroencephalography"[MeSH Terms] OR electroencephalogram[Text Word]
"microdialysis"[MeSH Terms] OR microdialysis[Text Word] OR cerebral microdyalisis [Text Word]
"near-infrared spectroscopy"[Text Word] OR "spectroscopy, near-infrared"[MeSH Terms] OR spectroscopy, near infrared[Text Word]
"calorimetry, indirect"[MeSH Terms] OR indirect calorimetry[Text Word]
(jugular[All Fields] AND venous[All Fields] AND bulb[All Fields] AND (("oximetry"[TIAB] NOT Medline[SB]) OR "oximetry"[MeSH
Terms]
(#1) OR (#02) OR (#03) OR (#04) OR (#05) OR (#06) OR (#07) OR (#08) OR (#09) OR (#10) OR (#11) OR (#12) OR (#13) OR (#14) OR
(#15)
"central venous pressure"[MeSH Terms] OR central venous pressure[Text Word]
(sedation[All Fields] AND monitoring[All Fields]) OR (Ramsay[All Fields] AND sedation[All Fields] AND score[All Fields]) OR
(Richmond[All Fields] AND (("weights and measures"[TIAB] NOT Medline[SB]) OR "weights and measures"[MeSH Terms] OR scale[Text
Word]))
(("pulmonary artery"[MeSH Terms] OR pulmonary artery[Text Word]) AND (("catheterization"[TIAB] NOT Medline[SB]) OR
"catheterization"[MeSH Terms] OR catheter[Text Word])) OR (right[All Fields] AND ("heart"[MeSH Terms] OR heart[Text Word]) AND
(("catheterization"[TIAB] NOT Medline[SB]) OR "catheterization"[MeSH Terms] OR catheter[Text Word]))
(transesophageal[All Fields] AND Doppler[All Fields])
#21
#22
#23
#24
#25
#26
#27
#28
#29
#30
#31
(arterial[All Fields] AND ("pressure"[MeSH Terms] OR pressure[Text Word]) AND monitoring[All Fields])
("cardiography, impedance"[MeSH Terms] OR impedance cardiography[Text Word])
(gastric[All Fields] AND intramucosal[All Fields] AND ("perfusion"[MeSH Terms]
((("abdomen"[TIAB] NOT Medline[SB]) OR "abdomen"[MeSH Terms] OR abdominal[Text Word]) AND ("pressure"[MeSH Terms] OR
pressure[Text Word]) AND monitoring[All Fields])
(mixed[All Fields] AND venous[All Fields] AND (("oximetry"[TIAB] NOT Medline[SB]) OR "oximetry"[MeSH Terms] OR oxygen
saturation[Text Word])) OR (central[All Fields] AND venous[All Fields] AND (("oximetry"[TIAB] NOT Medline[SB]) OR
"oximetry"[MeSH Terms] OR oxygen saturation[Text Word]))
(hepatic[All Fields] AND venous[All Fields] AND (("oximetry"[TIAB] NOT Medline[SB]) OR "oximetry"[MeSH Terms] OR oxygen
saturation[Text Word]))
((("mucous membrane"[TIAB] NOT Medline[SB]) OR "mucous membrane"[MeSH Terms] OR mucosal[Text Word]) AND ("laser-doppler
flowmetry"[MeSH Terms] OR laser Doppler flowmetry[Text Word]))
(#17) OR (#18) OR (#29) OR (#20) OR (#21) OR (#22) OR (#23) OR (#24) OR (#25) OR (#26) OR (#27)
(#16) OR (#28)
"randomized controlled trial"[Publication Type] OR "randomized controlled trials"[MeSH Terms] OR "randomized controlled trial"[Text
Word]
(#29) AND (#30)