Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/17877
Title: Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process.
Authors: Landoni, Giovanni;Pisano, Antonio;Lomivorotov, Vladimir;Alvaro, Gabriele;Hajjar, Ludhmila;Paternoster, Gianluca;Nigro Neto, Caetano;Latronico, Nicola;Fominskiy, Evgeny;Pasin, Laura;Finco, Gabriele;Lobreglio, Rosetta;Azzolini, Maria Luisa;Buscaglia, Giuseppe;Castella, Alberto;Comis, Marco;Conte, Adele;Conte, Massimiliano;Corradi, Francesco;Dal Checco, Erika;De Vuono, Giovanni;Ganzaroli, Marco;Garofalo, Eugenio;Gazivoda, Gordana;Lembo, Rosalba;Marianello, Daniele;Baiardo Redaelli, Martina;Monaco, Fabrizio;Tarzia, Valentina;Mucchetti, Marta;Belletti, Alessandro;Mura, Paolo;Musu, Mario;Pala, Giovanni;Paltenghi, Massimiliano;Pasyuga, Vadim;Piras, Desiderio;Riefolo, Claudio;Roasio, Agostino;Ruggeri, Laura;Santini, Francesco;Székely, Andrea;Verniero, Luigi;Vezzani, Antonella;Zangrillo, Alberto;Bellomo, Rinaldo
Affiliation: Division of Cardiac Anaesthesia and Intensive Care, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
Department of Anaesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria "Mater Domini," Catanzaro, Italy
Disciplina de Anestesia, Incor-Hospital das Clinicas, Sao Paulo, Brazil
Department of Cardiovascular Anaesthesia and Intensive Care, Ospedale San Carlo, Potenza, Italy
Dante Pazzanese Institute of Cardiology, Department of Anesthesia and Intensive Care, Sao Paulo, Brazil
Department of Anaesthesia and Intensive Care, Spedali Civili, Brescia, Italy
Department of Cardiac Anaesthesia and Intensive Care, San Giovanni Battista Hospital, University of Turin, Turin, Italy
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
Department of Cardiac Anaesthesia and Intensive Care, IRCCS University Hospital San Martino IST, Genova, Italy..
Cardiac and Vascular Department, Ospedale Mauriziano Umberto I, Torino, Italy
Department of Anesthesia and Intensive Care, Mater Dei Hospital, Bari, Italy
Department of Anaesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genova, Italy
Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Università degli Studi di Bologna-Azienda Ospedaliera Sant'Orsola-Malpighi, Bologna, Italy
Department of Anaesthesia and Intensive Care, Institute of Cardiovascular Diseases Dedinje, Belgrade, Serbia
Department of Thoracic and Cardiac Surgery, University of Siena, Siena, Italy
Anesthesia and Intensive Care Unit, Policlinico "Duilio Casula" AOU Cagliari, Department of Medical Sciences "M. Aresu," Cagliari, Italy
Department of Cardioanesthesia and Intensive Care, Ospedale Civile Santissima Annunziata, Sassari, Italy
Cardiac Anaesthesia and Intensive Care, Federal Centre for Cardiac Surgery, Astrakhan, Russia
Department of Anaesthesia and Intensive Care, Ospedale Cardinal Massaia di Asti, Asti, Italy
Division of Cardiac Surgery, IRCCS University Hospital San Martino IST, Genova, Ita
Department of Anaesthesiology and Intensive Care, Semmelweis Egyetem, Budapest, Hungary
Dipartimento Cardio-Nefro-Polmonare, Sezione Terapia Intensiva Cardiochirurgica, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Apr-2017
EDate: 2016-08-02
Citation: Journal of cardiothoracic and vascular anesthesia 2017; 31(2): 719-730
Abstract: 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. A web-based international consensus conference. The study comprised 500 clinicians from 61 countries. A systematic literature search was performed to identify published literature about nonsurgical interventions, supported by randomized evidence, showing a statistically significant impact on mortality. A consensus conference of experts discussed eligible papers. The interventions identified by the conference then were submitted to colleagues worldwide through a web-based survey. The authors identified 11 interventions contributing to increased survival (perioperative hemodynamic optimization, neuraxial anesthesia, noninvasive ventilation, tranexamic acid, selective decontamination of the gastrointestinal tract, insulin for tight glycemic control, preoperative intra-aortic balloon pump, leuko-depleted red blood cells transfusion, levosimendan, volatile agents, and remote ischemic preconditioning) and 2 interventions showing increased mortality (beta-blocker therapy and aprotinin). Interventions then were voted on by participating clinicians. Percentages of agreement among clinicians in different countries differed significantly for 6 interventions, and a variable gap between evidence and clinical practice was noted. The authors identified 13 nonsurgical interventions that may decrease or increase perioperative mortality, with variable agreement by clinicians. Such interventions may be optimal candidates for investigation in high-quality trials and discussion in international guidelines to reduce perioperative mortality.
URI: http://ahro.austin.org.au/austinjspui/handle/1/17877
DOI: 10.1053/j.jvca.2016.07.017
ORCID: 0000-0002-1650-8939
PubMed URL: 27693206
Type: Journal Article
Review
Subjects: anesthesia
consensus
intensive care
mortality
perioperative care
Appears in Collections:Journal articles

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