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

Antonio Pisano, Giovanni Landoni, Vladimir Lomivorotov, Marco Comis, Gordana Gazivoda, Massimiliano Conte, L. A. Hajjar, Gabriele Finco, Miomir Jovic, M. Mucchetti, Jan Kunstýř, Gianluca Paternoster, Valery Likhvantsev, Laura Ruggeri, Jun Ma, Gabriele Alvaro, Nazar Bukamal, Giovanni Borghi, Vadim Pasyuga, Luca CabriniMassimiliano Greco, Fabio Guarracino, Rosalba Lembo, Rosetta Lobreglio, Fabrizio Monaco, A. Montisci, Giovanni Pala, Laura Pasin, M. Pieri, Francesco Santini, S. Silvetti, Massimo Zambon, Martina Baiardo Redaelli, Alberto Castella, Giovanni De Vuono, Luca Lucchetta, Alberto Zangrillo, Rinaldo Bellomo

Research output: Contribution to journalReview article

Abstract

Objectives Democracy-based medicine is a combination of evidence-based medicine (systematic review), expert assessment, and worldwide voting by physicians to express their opinions and self-reported practice via the Internet. The authors applied democracy-based medicine to key trials in critical care medicine. Design and Setting A systematic review of literature followed by web-based voting on findings of a consensus conference. Participants A total of 555 clinicians from 61 countries. Interventions The authors performed a systematic literature review (via searching MEDLINE/PubMed, Scopus, and Embase) and selected all multicenter randomized clinical trials in critical care that reported a significant effect on survival and were endorsed by expert clinicians. Then they solicited voting and self-reported practice on such evidence via an interactive Internet questionnaire. Relationships among trial sample size, design, and respondents’ agreement were investigated. The gap between agreement and use/avoidance and the influence of country origin on physicians’ approach to interventions also were investigated. Measurements and Main Results According to 24 multicenter randomized controlled trials, 15 interventions affecting mortality were identified. Wide variabilities in both the level of agreement and reported practice among different interventions and countries were found. Moreover, agreement and reported practice often did not coincide. Finally, a positive correlation among agreement, trial sample size, and number of included centers was found. On the contrary, trial design did not influence clinicians’ agreement. Conclusions Physicians’ clinical practice and agreement with the literature vary among different interventions and countries. The role of these interventions in affecting survival should be further investigated to reduce both the gap between evidence and clinical practice and transnational differences.

Original languageEnglish
Pages (from-to)1386-1395
Number of pages10
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume30
Issue number5
DOIs
Publication statusPublished - Oct 1 2016

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Democracy
Politics
Critical Illness
Medicine
Critical Care
Physicians
Internet
Sample Size
Mortality
Randomized Controlled Trials
Evidence-Based Medicine
PubMed
MEDLINE
Survival
Surveys and Questionnaires

Keywords

  • anesthesia
  • consensus conference
  • critically ill
  • intensive care
  • mortality
  • survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Worldwide Opinion on Multicenter Randomized Interventions Showing Mortality Reduction in Critically Ill Patients : A Democracy-Based Medicine Approach. / Pisano, Antonio; Landoni, Giovanni; Lomivorotov, Vladimir; Comis, Marco; Gazivoda, Gordana; Conte, Massimiliano; Hajjar, L. A.; Finco, Gabriele; Jovic, Miomir; Mucchetti, M.; Kunstýř, Jan; Paternoster, Gianluca; Likhvantsev, Valery; Ruggeri, Laura; Ma, Jun; Alvaro, Gabriele; Bukamal, Nazar; Borghi, Giovanni; Pasyuga, Vadim; Cabrini, Luca; Greco, Massimiliano; Guarracino, Fabio; Lembo, Rosalba; Lobreglio, Rosetta; Monaco, Fabrizio; Montisci, A.; Pala, Giovanni; Pasin, Laura; Pieri, M.; Santini, Francesco; Silvetti, S.; Zambon, Massimo; Baiardo Redaelli, Martina; Castella, Alberto; De Vuono, Giovanni; Lucchetta, Luca; Zangrillo, Alberto; Bellomo, Rinaldo.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 30, No. 5, 01.10.2016, p. 1386-1395.

Research output: Contribution to journalReview article

Pisano, A, Landoni, G, Lomivorotov, V, Comis, M, Gazivoda, G, Conte, M, Hajjar, LA, Finco, G, Jovic, M, Mucchetti, M, Kunstýř, J, Paternoster, G, Likhvantsev, V, Ruggeri, L, Ma, J, Alvaro, G, Bukamal, N, Borghi, G, Pasyuga, V, Cabrini, L, Greco, M, Guarracino, F, Lembo, R, Lobreglio, R, Monaco, F, Montisci, A, Pala, G, Pasin, L, Pieri, M, Santini, F, Silvetti, S, Zambon, M, Baiardo Redaelli, M, Castella, A, De Vuono, G, Lucchetta, L, Zangrillo, A & Bellomo, R 2016, 'Worldwide Opinion on Multicenter Randomized Interventions Showing Mortality Reduction in Critically Ill Patients: A Democracy-Based Medicine Approach', Journal of Cardiothoracic and Vascular Anesthesia, vol. 30, no. 5, pp. 1386-1395. https://doi.org/10.1053/j.jvca.2016.05.005
Pisano, Antonio ; Landoni, Giovanni ; Lomivorotov, Vladimir ; Comis, Marco ; Gazivoda, Gordana ; Conte, Massimiliano ; Hajjar, L. A. ; Finco, Gabriele ; Jovic, Miomir ; Mucchetti, M. ; Kunstýř, Jan ; Paternoster, Gianluca ; Likhvantsev, Valery ; Ruggeri, Laura ; Ma, Jun ; Alvaro, Gabriele ; Bukamal, Nazar ; Borghi, Giovanni ; Pasyuga, Vadim ; Cabrini, Luca ; Greco, Massimiliano ; Guarracino, Fabio ; Lembo, Rosalba ; Lobreglio, Rosetta ; Monaco, Fabrizio ; Montisci, A. ; Pala, Giovanni ; Pasin, Laura ; Pieri, M. ; Santini, Francesco ; Silvetti, S. ; Zambon, Massimo ; Baiardo Redaelli, Martina ; Castella, Alberto ; De Vuono, Giovanni ; Lucchetta, Luca ; Zangrillo, Alberto ; Bellomo, Rinaldo. / Worldwide Opinion on Multicenter Randomized Interventions Showing Mortality Reduction in Critically Ill Patients : A Democracy-Based Medicine Approach. In: Journal of Cardiothoracic and Vascular Anesthesia. 2016 ; Vol. 30, No. 5. pp. 1386-1395.
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AU - Pisano, Antonio

AU - Landoni, Giovanni

AU - Lomivorotov, Vladimir

AU - Comis, Marco

AU - Gazivoda, Gordana

AU - Conte, Massimiliano

AU - Hajjar, L. A.

AU - Finco, Gabriele

AU - Jovic, Miomir

AU - Mucchetti, M.

AU - Kunstýř, Jan

AU - Paternoster, Gianluca

AU - Likhvantsev, Valery

AU - Ruggeri, Laura

AU - Ma, Jun

AU - Alvaro, Gabriele

AU - Bukamal, Nazar

AU - Borghi, Giovanni

AU - Pasyuga, Vadim

AU - Cabrini, Luca

AU - Greco, Massimiliano

AU - Guarracino, Fabio

AU - Lembo, Rosalba

AU - Lobreglio, Rosetta

AU - Monaco, Fabrizio

AU - Montisci, A.

AU - Pala, Giovanni

AU - Pasin, Laura

AU - Pieri, M.

AU - Santini, Francesco

AU - Silvetti, S.

AU - Zambon, Massimo

AU - Baiardo Redaelli, Martina

AU - Castella, Alberto

AU - De Vuono, Giovanni

AU - Lucchetta, Luca

AU - Zangrillo, Alberto

AU - Bellomo, Rinaldo

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N2 - Objectives Democracy-based medicine is a combination of evidence-based medicine (systematic review), expert assessment, and worldwide voting by physicians to express their opinions and self-reported practice via the Internet. The authors applied democracy-based medicine to key trials in critical care medicine. Design and Setting A systematic review of literature followed by web-based voting on findings of a consensus conference. Participants A total of 555 clinicians from 61 countries. Interventions The authors performed a systematic literature review (via searching MEDLINE/PubMed, Scopus, and Embase) and selected all multicenter randomized clinical trials in critical care that reported a significant effect on survival and were endorsed by expert clinicians. Then they solicited voting and self-reported practice on such evidence via an interactive Internet questionnaire. Relationships among trial sample size, design, and respondents’ agreement were investigated. The gap between agreement and use/avoidance and the influence of country origin on physicians’ approach to interventions also were investigated. Measurements and Main Results According to 24 multicenter randomized controlled trials, 15 interventions affecting mortality were identified. Wide variabilities in both the level of agreement and reported practice among different interventions and countries were found. Moreover, agreement and reported practice often did not coincide. Finally, a positive correlation among agreement, trial sample size, and number of included centers was found. On the contrary, trial design did not influence clinicians’ agreement. Conclusions Physicians’ clinical practice and agreement with the literature vary among different interventions and countries. The role of these interventions in affecting survival should be further investigated to reduce both the gap between evidence and clinical practice and transnational differences.

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KW - consensus conference

KW - critically ill

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KW - mortality

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