Original ArticleA Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Increasing Mortality
Section snippets
Methods
MEDLINE/PubMed, Scopus, and Embase were searched by 6 investigators to identify all RCTs concerning every kind of nonsurgical interventions influencing mortality in critically ill and perioperative patients, without publication time limits. The full MEDLINE/PubMed search strategy is available in the Supplemental Materials. These pieces of information also are reported in the mirror analysis on the intervention reducing mortality.15
Selected articles had to satisfy all the following criteria: (1)
Results
The authors report, for the first time, a list of all the RCTs ever performed in critically ill and perioperative settings showing a statistically significant increase in mortality. The complete list of the 262 identified manuscripts with mortality difference and the whole process of selection are reported in Supplemental Materials. The flowchart of the consensus process is summarized in Fig 1.
The journals that more frequently published the 15 ultimately selected manuscripts were the New
Key Findings
All nonsurgical interventions (drugs, techniques, strategies) that have been shown by at least 1 RCT to significantly affect unadjusted landmark mortality in critically ill adult patients, as well as in the perioperative period of any adult surgery, were identified systematically. Moreover, the authors assessed how these interventions were regarded by 251 clinicians (mostly anesthesiologists and/or intensivists) from around the world and the extent to which their opinions translate into
Conclusion
The updated international democracy-based, web-enabled consensus process identified 12 nonsurgical interventions (drugs, techniques, strategies) increasing mortality in critically ill or surgical patients according to at least 1 RCT and the results of a web-based survey involving 251 clinicians from 46 countries. Data on self-reported clinical practice about these interventions also were obtained. These findings may be useful to guide clinical practice and to direct future research.
The authors
Conflicts of Interest
There are no conflicts of interest for any of the authors.
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