Author’s response to the letter “Japanese clinical practice guidelines for rehabilitation in critically ill patients 2023 (J-ReCIP 2023)”

TL;DR

The authors respond to a critique of their 2023 guidelines on rehabilitation for critically ill patients, explaining their recommendation against endoscopy-based swallowing assessments.

Contribution

The paper clarifies the reasoning and clinical implications of a specific guideline recommendation in response to a published critique.

Findings

The authors defend their weak recommendation against endoscopy-based management for swallowing assessment in critically ill patients.

They explain the GRADE 2D rating is due to very low certainty in the evidence for this clinical question.

The response emphasizes the importance of clinical context and patient safety in guideline implementation.

Abstract

Recently, a Letter to the Editor critiquing the recommendations of the Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients, 2023, was published. The comment centered on the recommendation, "Weak recommendation against the use of endoscopy-based management (GRADE 2D: certainty of evidence = 'very low')" for the clinical question, "Should critically ill patients be managed based on video endoscopic assessment of swallowing?" In response, we outline the rationale behind our recommendations and their clinical implications.