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Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process
G. Landoni, V. Lomivorotov, S. Silvetti, C. Nigro Neto, A. Pisano, G. Alvaro, LA. Hajjar, G. Paternoster, H. Riha, F. Monaco, A. Szekely, R. Lembo, NA. Aslan, G. Affronti, V. Likhvantsev, C. Amarelli, E. Fominskiy, M. Baiardo Redaelli, A. Putzu,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, přehledy
- MeSH
- internet trendy MeSH
- kardiochirurgické výkony škodlivé účinky mortalita trendy MeSH
- kongresy jako téma trendy MeSH
- konsensuální konference jako téma * MeSH
- konsensus MeSH
- lidé MeSH
- mortalita trendy MeSH
- perioperační péče metody trendy MeSH
- pooperační komplikace mortalita prevence a kontrola MeSH
- randomizované kontrolované studie jako téma metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference. PARTICIPANTS: More than 400 physicians from 52 countries participated in this web-based consensus conference. INTERVENTIONS: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. MEASUREMENTS AND MAIN RESULTS: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. CONCLUSIONS: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field.
Anesthesia and Intensive Care Unit Busto Arsizio Hospital ASST Valle Olona Varese Italy
Dante Pazzanese Institute of Cardiology São Paulo Brazil
Department of Anaesthesia and Intensive Care Ospedale Cardinal Massaia di Asti Asti Italy
Department of Anesthesia and Intensive Care A O U Città della Salute e della Scienza Turin Italy
Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan Italy
Department of Anesthesia and Intensive Care Policlinico Universitario Mater Domini Catanzaro Italy
Department of Anesthesia and Intensive Care S Orsola Malpighi University Hospital Bologna Italy
Department of Anesthesia and Intensive Care Semmelweis Egyetem Budapest Hungary
Department of Cardiovascular Anaesthesia and Intensive Care Ospedale San Carlo Potenza Italy
Department of Cardiovascular Anesthesia and Intensive Care Cardiocentro Ticino Lugano Switzerland
Department of Cardiovascular Surgery and Transplants Monaldi Hospital Azienda dei Colli Naples Italy
Department of Surgical Sciences University of Turin Italy
Medipol Mega University Hospital Department of Anesthesiology and Intensive Care Istanbul Turkey
School of Medicine The University of Melbourne Parkville Melbourne Australia
Citace poskytuje Crossref.org
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- $a Landoni, Giovanni $u Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
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- $a OBJECTIVE: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference. PARTICIPANTS: More than 400 physicians from 52 countries participated in this web-based consensus conference. INTERVENTIONS: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. MEASUREMENTS AND MAIN RESULTS: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. CONCLUSIONS: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field.
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