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

{{JC info
| title= Mortality in Multicenter Critical Care Trials: An Analysis of Interventions With a Significant Effect
| abbreviation= 
| expansion=
| published= 2015-08
| author= Landoni G et al
| journal= Critical Care Medicine
| year= 2015
| volume= 43
| issue= 8
| pages= 1559–1568
| pmid= 25821918
| fulltexturl= http://journals.lww.com/ccmjournal/Abstract/2015/08000/Mortality_in_Multicenter_Critical_Care_Trials___An.2.aspx
| pdfurl= https://www.researchgate.net/profile/Laura_Pasin/publication/274262575_Mortality_in_Multicenter_Critical_Care_Trials_An_Analysis_of_Interventions_With_a_Significant_Effect/links/551c07250cf2fe6cbf7624d4.pdf
| status= Incomplete 
}}
==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==
 
==External Links==

==See Also==

==Funding==
Funded in part by departmental funds from the Department of Anesthesia & Intensive Care, IRCCSS San Raffaele Scientific Institute (Milan, Italy)

==References==
<references/>

[[Category:EBQ]]