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J Cardiothorac Vasc Anesth. 2018 Nov 22. pii: S1053-0770(18)31044-9. doi: 10.1053/j.jvca.2018.11.026. [Epub ahead of print]

A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality.

Author information

1
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
2
E. Meshalkin National Medical Research Center, Novosibirsk, Russia.
3
Hospital Universitari de Bellvitge, Barcelona, Spain.
4
Instituto do Coracao do Hospital das Clinicas, Sao Paulo, Brazil.
5
Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei Colli - Monaldi Hospital, Naples, Italy.
6
Department of Anesthesia and Intensive Care, First Moscow State Medical University, Moscow, Russian Federation.
7
Department of Cardiovascular Anesthesiology and Cardiac Intensive Medicine, University Hospital Dubrava, Zagreb, Croatia.
8
Saint Petersburg State University, Saint Petersburg, Russia.
9
San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy.
10
Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
11
Institute of Cardiovascular Diseases "Dedinje," Belgrade, Serbia.
12
Anaesthesia and Intensive Care San Carlo Hospital Potenza, Italy.
13
Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
14
AOU Mater Domini Germaneto, Catanzaro, Italy.
15
Anaesthesia and Intensive Care, University of Malaya, Kuala Lumpur, Malaysia.
16
Department of Anaesthesia and Intensive Care, Ospedale Cardinal Massaia di Asti, Asti, Italy.
17
Anaesthesia and Intensive Care, Hospital Pulau Pinang, Georgetown, Malaysia.
18
Department of Anesthesia and Intensive Care, A.O.U. Città della Salute e della Scienza, Turin, Italy.
19
Anesthesia and Intensive Care, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
20
S. Antonio Hospital, Padova, Italy.
21
Hospital Santa Chiara, Pisa, Italy.
22
Department of Anesthesia and Intensive Care Unit, Policlinico Duilio Casula AOU, Cagliari, Italy.
23
Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
24
Department Morphology, Surgery and Experimental Medicine, Intensive Care unit, University of Ferrara. Italy.
25
Mater Dei Hospital, Bari, Italy.
26
Anesthesia and Intensive Care, Azienda Ospedale San Camillo Rome.
27
IRCCS Istituto Giannina Gaslini - Ospedale Pediatrico, Genoa, Italy.
28
E.O. Ospedali Galliera, Genova, Italy and Università degli Studi di Pisa, Italy.
29
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
30
Australian and New Zealand Intensive Care Research Centre.
31
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.

Abstract

The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to "do you agree" and "do you use") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.

KEYWORDS:

anesthesia; consensus conference; critically ill; democracy-based medicine; intensive care; mortality; perioperative; survival

PMID:
30600204
DOI:
10.1053/j.jvca.2018.11.026

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