The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to "do you agree" and "do you use") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.

Anaesthesia and Intensive Care Hospital Pulau Pinang Georgetown Malaysia

Anaesthesia and Intensive Care San Carlo Hospital Potenza Italy

Anaesthesia and Intensive Care University of Malaya Kuala Lumpur Malaysia

Anesthesia and Intensive Care Azienda Ospedale San Camillo Rome

Anesthesia and Intensive Care Azienda Ospedaliera San Camillo Forlanini Rome Italy

AOU Mater Domini Germaneto Catanzaro Italy

Australian and New Zealand Intensive Care Research Centre

Center for Anesthesiology Beijing Anzhen Hospital Capital Medical University Beijing China

Department Morphology Surgery and Experimental Medicine Intensive Care unit University of Ferrara Italy

Department of Anaesthesia and Intensive Care Ospedale Cardinal Massaia di Asti Asti Italy

Department of Anesthesia and Intensive Care 1st Moscow State Medical University Moscow Russian Federation

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 IRCCS San Raffaele Scientific Institute Milan Italy; Vita Salute San Raffaele University Milan Italy

Department of Anesthesia and Intensive Care Unit Policlinico Duilio Casula AOU Cagliari Italy

Department of Cardiovascular Anesthesiology and Cardiac Intensive Medicine University Hospital Dubrava Zagreb Croatia

Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy

Division of Cardiac Anesthesia and Intensive Care Unit AORN dei Colli Monaldi Hospital Naples Italy

E Meshalkin National Medical Research Center Novosibirsk Russia

E O Ospedali Galliera Genova Italy and Università degli Studi di Pisa Italy

Hospital Santa Chiara Pisa Italy

Hospital Universitari de Bellvitge Barcelona Spain

Institute for Clinical and Experimental Medicine Prague Czech Republic

Institute of Cardiovascular Diseases Dedinje Belgrade Serbia

Instituto do Coracao do Hospital das Clinicas Sao Paulo Brazil

IRCCS Istituto Giannina Gaslini Ospedale Pediatrico Genoa Italy

Mater Dei Hospital Bari Italy

S Antonio Hospital Padova Italy

Saint Petersburg State University Saint Petersburg Russia

San Raffaele Telethon Institute for Gene Therapy IRCCS San Raffaele Scientific Institute Milan Italy

J Cardiothorac Vasc Anesth. 2019 May;33(5):1440-1441. doi: 10.1053/j.jvca.2019.01.012. PubMed

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