Mortality in Multicenter Critical Care Trials

Landoni, Giovanni; Comis, Marco; Conte, Massimiliano; Finco, Gabriele; Mucchetti, Marta; Paternoster, Gianluca; Pisano, Antonio; Ruggeri, Laura; Alvaro, Gabriele; Angelone, Manuela; Bergonzi, P. C.; Bocchino, Speranza; Borghi, Giovanni; Bove, Tiziana; Buscaglia, Giuseppe; Cabrini, Luca; Callegher, Lino; Caramelli, Fabio; Colombo, Sergio; Corno, Laura; Sarto, Paolo Del; Feltracco, Paolo; Forti, Alessandro; Ganzaroli, Marco; Greco, Massimiliano; Guarracino, Fabio; Lembo, Rosalba; Lobreglio, Rosetta; Meroni, Roberta; Monaco, Fabrizio; Musu, Mario; Pala, Giovanni; Pasin, Laura; Pieri, Marina; Pisarra, Stefania; Ponticelli, Giuseppe; Roasio, Agostino; Santini, Francesco; Silvetti, Simona; Székely, Andrea; Zambon, Massimo; Zucchetti, Martina; Zangrillo, Alberto; Bellomo, Rinaldo

doi:10.1097/ccm.0000000000000974

Cited by 74 publications

(24 citation statements)

References 36 publications

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“…Moreover, we analyzed how these interventions are regarded by a large cohort of colleagues worldwide, and to what extent they translate into reported clinical practice. Through a well-proven "democratic" consensus process which has been widely described, [4][5][6][7][8]54 the systematic review of literature was limited to the highest levels of evidence-based medicine (EBM) hierarchy and filtered through the views and the experience of 500 clinicians from 61 countries. This is a unique feature of our consensus processes, which allows physicians to directly provide their opinion on perioperative interventions associated with increase or reduction in survival.…”

Section: Key Findingsmentioning

confidence: 99%

“…[4][5][6][7][8] Since evidence seems to be constantly and rapidly evolving, we Page 5 of 39 conducted an update of a previous consensus process on ancillary (nonsurgical) interventions (drugs/techniques/strategies) which have been shown by at least one randomized controlled trial (RCT) or meta-analysis of RCTs to affect perioperative mortality in any adult surgical setting. In addition to a systematic literature search, consensus meeting and web-based survey about the agreement on the included interventions, we investigated the reported use in clinical practice of such interventions and the possible gap between literature evidence and clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Landoni

Pisano

Lomivorotov

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality

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Section: Key Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Landoni

Pisano

Lomivorotov

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

View full text Add to dashboard Cite

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“…This has the eminent risk of overestimating benefit and underestimating harm 49. In a recently published systematic review, eight critical care interventions used in clinical practice were shown to increase mortality 50. Furthermore, there is empirical evidence within critical care that research results based on data from trials with lower quality have changed direction once higher quality trials were published 51.…”

Section: Discussionmentioning

confidence: 99%

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Møller

Granholm

Junttila

et al. 2018

Acta Anaesthesiol Scand

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BackgroundAdult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient‐important treatment recommendations on this topic.MethodsThis guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock. We assessed patient‐important outcome measures, including mortality and serious adverse reactions.ResultsFor all patients, we suggest against the routine use of any inotropic agent, including dobutamine, as compared to placebo/no treatment (very low quality of evidence). For patients with shock in general, and in those with septic and other types of shock, we suggest using dobutamine rather than levosimendan or epinephrine (very low quality of evidence). For patients with cardiogenic shock and in those with shock after cardiac surgery, we suggest using dobutamine rather than milrinone (very low quality of evidence). For the other clinical questions, we refrained from giving any recommendations or suggestions.ConclusionsWe suggest against the routine use of any inotropic agent in adult patients with shock. If used, we suggest using dobutamine rather than other inotropic agents for the majority of patients, however, the quality of evidence was very low, implying high uncertainty on the balance between the benefits and harms of inotropic agents.

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“…Importantly, surrogate outcome measures overestimate intervention effects by 40–50%, compared to patient‐centred outcome measures 27. In a recently published analysis of multicentre trials of critical care interventions, eight interventions were shown to actually increase mortality 28. Also, there is empirical evidence that guideline recommendations based on data from trials with lower quality have changed direction once higher quality trials have been published 29.…”

Section: Discussionmentioning

confidence: 99%

Scandinavian SSAI clinical practice guideline on choice of first‐line vasopressor for patients with acute circulatory failure

Møller

Claudius

Junttila

et al. 2016

Acta Anaesthesiol Scand

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BackgroundAdult critically ill patients often suffer from acute circulatory failure, necessitating use of vasopressor therapy. The aim of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force for Acute Circulatory Failure was to present clinically relevant, evidence‐based treatment recommendations on this topic.MethodsThis guideline was developed according to standards for trustworthy guidelines, including a systematic review of the literature and use of the GRADE methodology for assessment of the quality of evidence and for moving from evidence to recommendations. We assessed the following subpopulations of patients with acute circulatory failure: 1) shock in general, 2) septic shock, 3) cardiogenic shock, 4) hypovolemic shock and 5) other types of shock, including vasodilatory shock. We assessed patient‐important outcome measures, including mortality, serious adverse reactions and quality‐of‐life.ResultsFor patients with shock in general and those with septic shock, we recommend using norepinephrine rather than dopamine, and we suggest using norepinephrine rather than epinephrine, vasopressin analogues, and phenylephrine. For patients with cardiogenic shock and those with hypovolemic shock, we suggest using norepinephrine rather than dopamine, and we provide no recommendations/suggestions of norepinephrine vs. epinephrine, vasopressin analogues, and phenylephrine. For patients with other types of shock, including vasodilatory shock, we suggest using norepinephrine rather than dopamine, epinephrine, vasopressin analogues, and phenylephrine.ConclusionsWe recommend using norepinephrine rather than other vasopressors as first‐line treatment for the majority of adult critically ill patients with acute circulatory failure.

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Mortality in Multicenter Critical Care Trials

Cited by 74 publications

References 36 publications

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Scandinavian SSAI clinical practice guideline on choice of first‐line vasopressor for patients with acute circulatory failure

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