“Reducing Mortality in Adult Critically Ill Patients with Drugs or Non-Surgical Techniques/Strategies: Randomized Evidence”

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Interventions that increase mortality

The following 16 drugs/techniques/strategies increase mortality in adult critically ill patients according to at least one randomized controlled trial (RCT) published in a peer-reviewed journal.

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Do you routinely avoid these interventions in your clinical practice?
Would you include the avoidance of these interventions into future international guidelines to reduce mortality in critically ill patients?

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Albumin in traumatic brain injury

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Albumin increases mortality in traumatic brain injury (1 mRCT).

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Do you routinely avoid this intervention in your clinical practice?
Yes No Does not apply

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Diaspirin cross linked hemoglobin in severe traumatic hemorragic shock

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Diaspirin cross linked hemoglobin increases mortality in severe traumatic hemorragic shock (1 mRCT).

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Yes No Does not apply

Would you include the avoidance of these interventions into future international guidelines to reduce mortality in critically ill patients?
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Growth hormone in critically ill patients

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Human growth hormone increases mortality in critically ill patients (1 mRCT).

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Yes No Does not apply

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High frequency oscillation ventilation in acute respiratory distress syndrome

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High frequency oscillation ventilation increases mortality in acute respiratory distress syndrome (1 mRCT).

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Yes No Does not apply

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Hypothermia in meningitis

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Hypotermia in meningitis increases mortality (1 mRCT).

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Yes No Does not apply

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Intravenous salbutamol in acute respiratory distress syndrome

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Intravenous salbutamol increases 28-days mortality in acute respiratory distress patients (1 mRCT).

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Do you routinely avoid this intervention in your clinical practice?
Yes No Does not apply

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L-2-oxothiazolidine-4-carboxylic acid in acute respiratory distress syndrome

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Cysteine prodrug (L-2-oxothiazolidine-4-carboxylic acid) increases mortality in patients with ARDS (1 mRCT).

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Yes No Does not apply

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Methylprednisolone in sepsis

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Methylprednisolone increases mortality in sepsis with elevated creatinine levels (>2 mg/dL) (1 mRCT).

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Do you routinely avoid this intervention in your clinical practice?
Yes No Does not apply

Would you include the avoidance of these interventions into future international guidelines to reduce mortality in critically ill patients?
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Methylprednisolone in traumatic brain injury

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Methylprednisolone increases mortality in traumatic brain injury (1mRCT)

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Do you routinely avoid this intervention in your clinical practice?
Yes No Does not apply

Would you include the avoidance of these interventions into future international guidelines to reduce mortality in critically ill patients?
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Nitric oxide synthase inhibitor 546C88 in septic shock

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Nitric oxide synthase inhibitor 546C88 increases mortality in septic shock (1mRCT).

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Do you routinely avoid this intervention in your clinical practice?
Yes No Does not apply

Would you include the avoidance of these interventions into future international guidelines to reduce mortality in critically ill patients?
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Overfeeding in acute lung injury

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Intensive nutrition program (overfeeding) increases mortality (1 sRCT).

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Do you routinely avoid this intervention in your clinical practice?
Yes No Does not apply

Would you include the avoidance of these interventions into future international guidelines to reduce mortality in critically ill patients?
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Protein C zymogen in severe sepsis

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Protein C zymogen increases mortality in septic patients (1 sRCT).

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Yes No Does not apply

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Thyroxine in acute kidney injury

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Thyroxin for AKI treatment increases mortality in euthyroid intensive care unit patients (1 sRCT).

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Tumor necrosis factor fusion protein in severe sepsis

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Tumor necrosis factor fusion protein increases mortality in septic shock (2 mRCTs).

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Yes No Does not apply

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Aprotinin in cardiac surgery

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Aprotinin increases 30-day mortality in adult patients undergoing high-risk cardiac surgery (1 mRCT)

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Yes No Does not apply

Would you include the avoidance of these interventions into future international guidelines to reduce mortality in critically ill patients?
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Metoprolol retard in non-cardiac surgery

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Metoprolol retard increases perioperative mortality in non cardiac surgery (1 mRCT).

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Do you routinely avoid this intervention in your clinical practice?
Yes No Does not apply

Would you include the avoidance of these interventions into future international guidelines to reduce mortality in critically ill patients?
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Interventions that decrease mortality

The following 36 drugs/techniques/strategies decrease mortality in adult critically ill patients according to at least one multicenter randomized controlled trial (mRCT) published in peer-reviewed journals.

Do you agree with the below sentence?
Do you routinely use these intervention in your clinical practice?
Would you include this intervention into future international guidelines to reduce perioperative mortality?

Please notify comments or potential conflicts of interest in the dedicated area.


Albumin in cirrhosis

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Albumin reduces mortality in patients with cirrhosis and spontaneous bacterial peritonitis (1 mRCT).

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Do you routinely use this intervention in your clinical practice?
Yes No Does not apply

Would you include this intervention into future international guidelines to reduce perioperative mortality?
Yes No Do not know

Please notify potential Conflict of interest or comments


Amiodarone in out of hospital cardiac arrest

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Amiodarone reduces mortality to hospital admission in out-of-hospital cardiopulmonary resuscitation (3 mRCTs).

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Would you include this intervention into future international guidelines to reduce perioperative mortality?
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Antithrombin III in septic shock and burn injured patients

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Antithrombin III reduces mortality in septic and burn injured patients (1 sRCT and 2 mRCTs).

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Yes No Do not know

Would you include this intervention into future international guidelines to reduce perioperative mortality?
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Atropine in out of hospital cardiac arrest

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Atropine reduces mortality to hospital admission in out of hospital cardiac arrest (1 sRCT).

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Clopidogrel after myocardial infarction

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Clopidogrel reduces mortality after acute myocardial infarction (1 mRCT).

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Combination of vasopressin with epinephrine with or without steroids in cardiac arrest

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Vasopressin with or without steroids reduces mortality cardiac arrest patients (2 sRCTs, 1mRCT).

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Decontamination of the digestive tract

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Selective decontamination of the digestive tract reduces mortality of critically ill patients (4 sRCTs, 1 mRCT).

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Deep sedation

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Avoidance of deep sedation reduces mortality (2 sRCTs, 1mRCT).

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Would you include this intervention into future international guidelines to reduce perioperative mortality?
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Early defibrillation in out of hospital cardiac arrest

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Early defibrillation by trained rescuers reduces hospital mortality in out of hospital cardiac arrest (1 sRCT and 1 mRCT).

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Early thrombolytic therapy in acute myocardial infarction and pulmonary embolism

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Early thrombolytic therapy in acute myocardial infarction and pulmonary embolism reduces mortality (4 sRCTs).

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Early tracheostomy

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Early tracheostomy in severe stroke and early percutaneous tracheotomy in medical patients requiring prolonged ventilation (>14 days) reduce mortality (1sRCT, 1 mRCT).

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Epinephrine in cardiac arrest

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Epinephrine reduces mortality in cardiac arrest (1 sRCT supported by guidelines)

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Erythropoietin

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Erythropoietin reduces mortality in critically ill (including trauma) patients, especially those with APACHE score <=20 (2 mRCT).

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Would you include this intervention into future international guidelines to reduce perioperative mortality?
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"

Esmolol in septic shock

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Esmolol reduces mortality in patients with septic shock (3 sRCTs).

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Do you routinely use these interventions in your clinical practice?
Yes No Do not know

Would you include this intervention into future international guidelines to reduce perioperative mortality?
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Please notify potential conflict of interest or comments

"

Goal directed therapy based on hemodynamic parameters

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Goal directed therapy reduces hospital mortality in patients with septic shock (2 sRCTs).

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High flow nasal cannulae in acute respiratory failure

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High flow nasal cannulae reduces mortality in patients with acute respiratory failure (1 mRCT).

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Hydrocortisone in community acquired pneumonia

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Hydrocortisone reduces mortality in community acquired pneumonia (1 mRCT).

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Hydrocortisone in sepsis

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Hydrocortisone reduces mortality in septic shock (1 mRCT).

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Do you routinely use these interventions in your clinical practice?
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Levosimendan in cardiogenic shock and low cardiac output syndrome

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Levosimendan reduces mortality in patients with cardiogenic shock and low cardiac output syndrome (1 sRCT, 1 mRCT).

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Mechanical chest compression in cardiac arrest

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Mechanical chest compression devices reduce short term mortality in cardiac arrest (3 sRCTs, 1 mRCT).

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Non invasive ventilation in acute respiratory failure

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Non invasive ventilation reduces mortality in acute respiratory failure in patients with pulmonary edema and/or hypoxemic-hypercapnic respiratory failure (3 sRCTs and 3 mRCTs).

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Non invasive ventilation in chronic obstructive pulmonary disease

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Non invasive ventilation reduces mortality in patients with chronic obstructive pumonary disease (2 mRCTs).

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Non invasive ventilation in weaning

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Non invasive ventilation reduces mortality during the weaning after extubation (2 sRCTs and 4 mRCTs).

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Polymyxin B fibers

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Polymyxin B fibers reduce mortality (2 sRCTs and 1 mRCT).

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Procalcitonin-guided antibiotics discontinuation

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Procalcitonin-guided antibiotic discontinuation reduces mortality of critically ill patients (1 mRCT).

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Prone positioning in ARDS

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Prone positioning reduces mortality in early severe acute respiratory distress syndrome patients (P/F< 150) especially if it is used early and in relatively long sessions (17-18 hours) (3 mRCTs).

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Protective ventilation with low tidal volumes

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Protective ventilation with low tidal volumes (6 ml/kg) reduces mortality (3 mRCTs).

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Pulmonary artery catheter

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The use of pulmonary artery catheter reduces mortality in critically ill patients (4 old sRCTs).

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Restrictive inspiratory oxygen fraction

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Restrictive inspiratory oxygen fraction reduces mortality in intensive care unit patients and in the perioperative setting (1 sRCT and 1 mRCT).

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Selenium in sepsis

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Selenium reduces mortality in patients with sepsis (1 mRCT).

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Tranexamic acid in traumatic bleeding

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Tranexamic acid in traumatic bleeding patients reduces 28-day mortality (1 mRCT).

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Underfeeding in refeeding syndrome

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Underfeeding reduces mortality in patients with refeeding syndrome (1 mRCT).

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Vitamin C in intensive care unit

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Vitamin C reduces mortality in ICU patients (1 sRCT and 1 mRCT).

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Leukocyte-depleted blood transfusions in cardiac surgery

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Leukocyte-depleted blood transfusions reduce mortality in cardiac surgery (1 sRCT, 1 mRCT).

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Liberal perioperative red blood cell transfusion strategy

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A liberal red blood cell transfusion strategy reduces mortality in cardiac and non cardiac surgery (2 sRCTs and 1 mRCT).

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Volatile anaesthetics in cardiac surgery

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Volatile anaesthetics reduce mortality in cardiac surgery (2 mRCTs).

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