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

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art_LANDONI_Randomized_Evidence_for_Reduction_of_Perioperative_Mortality_An_2017.PDF (622.49 KB)
Citações na Scopus
45
Tipo de produção
article
Data de publicação
2017
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
W B SAUNDERS CO-ELSEVIER INC
Autores
LANDONI, Giovanni
PISANO, Antonio
LOMIVOROTOV, Vladimir
ALVARO, Gabriele
PATERNOSTER, Gianluca
NETO, Caetano Nigro
LATRONICO, Nicola
FOMINSKIY, Evgeny
PASIN, Laura
Citação
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, v.31, n.2, p.719-730, 2017
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objective: 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. Design and Setting: A web-based international consensus conference. Participants: The study comprised 500 clinicians from 61 countries. Interventions: 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. Measurements and Main Results: 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. Conclusions: 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.
Palavras-chave
perioperative care, mortality, consensus, anesthesia, intensive care
URI
https://observatorio.fm.usp.br/handle/OPI/19984
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/08