What have we learned from network meta-analyses applied to critical care?

Area of Science:

• Critical Care Medicine
• Biostatistics
• Evidence-Based Practice

Background:

• Clinical decisions require scientific evidence, posing challenges when multiple interventions exist.
• Traditional meta-analysis (TMA) synthesizes direct head-to-head study comparisons.
• Network meta-analysis (NMA) extends this by incorporating indirect evidence from non-head-to-head studies.

Purpose of the Study:

• To illustrate the features, applications, and interpretation of NMA in critical care.
• To demonstrate how NMA can improve clinical practice and strengthen guideline recommendations.
• To provide practical tools for conducting NMA and reproducing results.

Main Methods:

• This narrative review selected PubMed manuscripts relevant to NMA in critical care.
• The review describes NMA interpretation, assumptions, and visualization plots.
• Examples of NMA in critical care are analyzed, along with a pragmatic approach to implementation.

Main Results:

• NMA allows comparison of multiple interventions, even without direct head-to-head studies.
• NMA increases result accuracy and enables ranking of interventions by effectiveness.
• NMA strengthens clinical practice guidelines and can generate new research hypotheses.

Conclusions:

• Network meta-analysis is an established, robust, and reproducible statistical method.
• NMA is increasingly applied in critical care and is being incorporated into clinical guidelines.
• The applicability of NMA is expected to expand across critical care medicine.