Methodology series of ESAIC guidelines: standards in guidelines production

Over the past decade, clinical guideline development has undergone significant advancements, with an increased focus on rigour, transparency and stakeholder engagement. In this study, the first in a series of four articles, the European Society of Anaesthesiology and Intensive Care (ESAIC) outlines key principles that guide the development of high-quality guidelines within ESAIC. Starting in 2025, ESAIC will progressively adopt the GRADE approach to enhance the quality and applicability of its guidelines. Core methodological principles include the use of systematic reviews, a multidisciplinary development process, conflict-of-interest management, a transparent link between evidence and recommendations, and ensuring that recommendations are specific and actionable. This study provides an overview of the roles and processes involved in guideline production and details the transition of ESAIC from its traditional grading systems to the updated GRADE standards. Strong recommendations indicate that one option offers a clear net benefit and should be implemented with all or nearly all patients. In contrast, conditional recommendations reflect uncertainty in the balance between benefits and harms, emphasising the need for careful consideration of clinical contexts and patient values. Although specific methodological decisions may vary, the principles outlined here provide a foundation for rigorous, evidence-based guideline development within ESAIC.