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

Sartini, Chiara and Lomivorotov, Vladimir and Pisano, Antonio and Riha, Hynek and Baiardo Redaelli, Martina and Lopez-Delgado, Juan Carlos and Pieri, Marina and Hajjar, Ludhmila and Fominskiy, Evgeny and Likhvantsev, Valery and Cabrini, Luca and Bradic, Nikola and Avancini, Daniele and Wang, Chew Yin and Lembo, Rosalba and Novikov, Maxim and Paternoster, Gianluca and Gazivoda, Gordana and Alvaro, Gabriele and Roasio, Agostino and Wang, Chengbin and Severi, Luca and Pasin, Laura and Mura, Paolo and Musu, Mario and Silvetti, Simona and Votta, Carmine Domenico and Belletti, Alessandro and Corradi, Francesco and Brusasco, Claudia and Tamà, Simona and Ruggeri, Laura and Yong, Chow-Yen and Pasero, Daniela and Mancino, Giuseppe and Spadaro, Savino and Conte, Massimiliano and Lobreglio, Rosetta and Di Fraja, Diana and Saporito, Emanuela and D'Amico, Alessandro and Sardo, Salvatore and Ortalda, Alessandro and Yavorovskiy, Andrey and Riefolo, Claudio and Monaco, Fabrizio and Bellomo, Rinaldo and Zangrillo, Alberto and Landoni, Giovanni (2019) A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Increasing Mortality. Journal of Cardiothoracic and Vascular Anesthesia, 33 (10). pp. 2685-2694. ISSN 1053-0770, DOI https://doi.org/10.1053/j.jvca.2019.03.022.

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Official URL: https://doi.org/10.1053/j.jvca.2019.03.022


Objective: Reducing mortality is a key target in critical care and perioperative medicine. The authors aimed to identify all nonsurgical interventions (drugs, techniques, strategies) shown by randomized trials to increase mortality in these clinical settings. Design: A systematic review of the literature followed by a consensus-based voting process. Setting: A web-based international consensus conference. Participants: Two hundred fifty-one physicians from 46 countries. Interventions: The authors performed a systematic literature search and identified all randomized controlled trials (RCTs) showing a significant increase in unadjusted landmark mortality among surgical or critically ill patients. The authors reviewed such studies during a meeting by a core group of experts. Studies selected after such review advanced to web-based voting by clinicians in relation to agreement, clinical practice, and willingness to include each intervention in international guidelines. Measurements and Main Results: The authors selected 12 RCTs dealing with 12 interventions increasing mortality: diaspirin-crosslinked hemoglobin (92% of agreement among web voters), overfeeding, nitric oxide synthase inhibitor in septic shock, human growth hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute respiratory distress syndrome, plasma-derived protein C concentrate, aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in meningitis, methylprednisolone in traumatic brain injury, and albumin in traumatic brain injury (72% of agreement). Overall, a high consistency (ranging from 80% to 90%) between agreement and clinical practice was observed. Conclusion: The authors identified 12 clinical interventions showing increased mortality supported by randomized controlled trials with nonconflicting evidence, and wide agreement upon clinicians on a global scale. © 2019 Elsevier Inc.

Item Type: Article
Uncontrolled Keywords: anesthesia; mortality; consensus conference; critically ill; perioperative; democracy-based medicine
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 22 Jan 2020 01:15
Last Modified: 22 Jan 2020 01:15
URI: http://eprints.um.edu.my/id/eprint/23517

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