EBQ:Mortality in Multicenter Critical Care Trials: An Analysis of Interventions with a Significant Effect

Incomplete Journal Club Article

Landoni G et al. "Mortality in Multicenter Critical Care Trials: An Analysis of Interventions With a Significant Effect". Critical Care Medicine. 2015. 43(8):1559–1568.
PubMed Full text PDF

Clinical Question

What interventions have been shown in multicenter RCT's to affect mortality in adult critically ill patients?

Conclusion

Of all the interventions done in critical care, the authors of this study identified 15 total treatments that increased or decreased mortality as documented in a randomized, controlled trail.

The following interventions decreased mortality:

1. Noninvasive Ventilation
2. Mild hypothermia after cardiac arrest
3. Prone Positioning
4. Low tidal volume ventilation in ARDS
5. TXA in patients with or at high risk of traumatic hemorrhagic shock
6. Daily interruption of sedatives in critically ill patients
7. Albumin in cirrhotic patients with SBP

The following interventions increased mortality:

1. Diaspirin cross linked hemoglobin in traumatic hemorrhagic shock
2. Starch in septic shock
3. Ventilation with high frequency oscillation
4. IV Salbutamol in ARDS
5. Glutamine supplementation
6. Growth hormone treatment
7. Supernormal systemic oxygen delivery
8. Intensive insulin therapy

Study Design

• Systematic search & review of the literature involving multi center RCT's of interventions influencing mortality in critically ill patients.
• Search via MEDLINE, Pubmed Scopus, Embase
• Consensus conference of experts participated in an in person meeting to evaluate the methodological robustness of all interventions studies to determine if individual papers should be included in the review