Worldwide Opinion on Multicenter Randomized Interventions Showing Mortality Reduction in Critically Ill Patients: A Democracy-Based Medicine Approach

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

“…Since methodological research suggests, as we mentioned previously, 6 that there is no difference in response rate depending on the inclusion or exclusion of the "do not know" option (if less than 40%), in the results we reported only the "yes" and "no" frequencies if not otherwise indicated. 8 After the second last web vote, the interventions that reached less than 67% of agreement were considered as major exclusions and are available in Supplemental Table 1. The interventions with an impact on mortality that were approved after the web vote, with the references to the papers of RCTs or metaanalyses of RCTs supporting the evidence are reported in Table 2 if overwhelming evidence was not Page 7 of 39 published thereafter.…”

“…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.…”

“…[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.…”

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

“…The final list of 27 interventions and 66 manuscripts which reached consensus after the web vote is presented in table 1 and in supplemental materials (table s3) The Journals that more frequently published the 66 selected manuscripts were NEJM (13 papers), Lancet (7) and JAMA (5). Overall, 251 physicians from 46 countries ( Figure 2) participated in the web survey.…”

“…This lower limit of agreement was chosen because two-thirds of voters represent a "qualified majority" in many political or administrative proceedings. This choice is similar to previous "democracy-based" consensus conferences the authors have conducted in other clinical settings 5,6 .…”