EBQ:Mortality in Multicenter Critical Care Trials: An Analysis of Interventions with a Significant Effect: Difference between revisions
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Revision as of 19:22, 18 January 2016
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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:
- Noninvasive Ventilation
- Mild hypothermia after cardiac arrest
- Prone Positioning
- Low tidal volume ventilation in ARDS
- TXA in patients with or at high risk of traumatic hemorrhagic shock
- Daily interruption of sedatives in critically ill patients
- Albumin in cirrhotic patients with SBP
The following interventions increased mortality:
- Diaspirin cross linked hemoglobin in traumatic hemorrhagic shock
- Starch in septic shock
- Ventilation with high frequency oscillation
- IV Salbutamol in ARDS
- Glutamine supplementation
- Growth hormone treatment
- Supernormal systemic oxygen delivery
- Intensive insulin therapy
Major Points
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
Article Selection
Inclusion Criteria
In order to be included in the review, articles need to see the following 4 criteria:
- Publication in a peer reviewed journal
- mRCT design (m = any trial involving more than one hospital)
- Dealing with nonsurgical interventions in adult critically ill patients
- Statistical significant reduction or increase in unadjusted landmark mortality
[For the purpose of this review, critically ill patients referred to those patients with acute failure of at least one organ and/or need for intensive/emergent treatment, regardless of where they were treated (ICU, ED, etc.)]
Exclusion Criteria
All studies were excluded that fulfilled any of the following:
- Quasi randomized or non randomized methods
- Dealt with surgical interventions
- Involved pediatric population
- Dealt with only the perioperative period
- Were performed out of the hospital
- Showed mortality effect only in a subgroup or after adjusted analysis
- Had low (<50%) agreement levels among surveyed clinicians
Results
A total of 15 interventions were identified from the selected 24 total studies that were included in this paper.
Interventions That Decreased Mortality
Interventions That Increased Mortality
Characteristics of Trials Selected
Criticisms & Further Discussion
See Also
Funding
Funded in part by departmental funds from the Department of Anesthesia & Intensive Care, IRCCSS San Raffaele Scientific Institute (Milan, Italy)