title: Worldwide Opinion on Multicenter Randomized Interventions Showing Mortality Reduction in Critically Ill Patients: A Democracy-Based Medicine Approach.
abstract: OBJECTIVE
  Democracy-based medicine is a combination of evidence-based medicine (systematic review), expert assessment, and worldwide voting by physicians to express their opinions and self-reported practice via the Internet. The authors applied democracy-based medicine to key trials in critical care medicine.
  
  
  METHODS
  A systematic review of literature followed by web-based voting on findings of a consensus conference.
  
  
  METHODS
  A total of 555 clinicians from 61 countries.
  
  
  METHODS
  The authors performed a systematic literature review (via searching MEDLINE/PubMed, Scopus, and Embase) and selected all multicenter randomized clinical trials in critical care that reported a significant effect on survival and were endorsed by expert clinicians. Then they solicited voting and self-reported practice on such evidence via an interactive Internet questionnaire. Relationships among trial sample size, design, and respondents' agreement were investigated. The gap between agreement and use/avoidance and the influence of country origin on physicians' approach to interventions also were investigated.
  
  
  RESULTS
  According to 24 multicenter randomized controlled trials, 15 interventions affecting mortality were identified. Wide variabilities in both the level of agreement and reported practice among different interventions and countries were found. Moreover, agreement and reported practice often did not coincide. Finally, a positive correlation among agreement, trial sample size, and number of included centers was found. On the contrary, trial design did not influence clinicians' agreement.
  
  
  CONCLUSIONS
  Physicians' clinical practice and agreement with the literature vary among different interventions and countries. The role of these interventions in affecting survival should be further investigated to reduce both the gap between evidence and clinical practice and transnational differences.
authors: Division of Cardiac Anesthesia and Intensive Care, AORN "Dei Colli", Monaldi Hospital, Naples, Italy.
authors: Antonio
authors: A
authors: Pisano
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
authors: Giovanni
authors: G
authors: Landoni
authors: Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors: Vladimir
authors: V
authors: Lomivorotov
authors: Cardiac and Vascular Department, Mauriziano Hospital, Turin, Italy.
authors: Marco
authors: M
authors: Comis
authors: Institute of Cardiovascular Diseases ׳Dedinje׳, Belgrade, Serbia.
authors: Gordana
authors: G
authors: Gazivoda
authors: Department of Anesthesia and Intensive Care, Mater Dei Hospital, Bari, Italy.
authors: Massimiliano
authors: M
authors: Conte
authors: Intensive Care Unit, Universidade de Sao Paulo, Sao Paulo, Brazil.
authors: Ludhmila
authors: L
authors: Hajjar
authors: Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy.
authors: Gabriele
authors: G
authors: Finco
authors: Institute of Cardiovascular Diseases ׳Dedinje׳, Belgrade, Serbia.
authors: Miomir
authors: M
authors: Jovic
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Marta
authors: M
authors: Mucchetti
authors: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, Prague, Czech Republic.
authors: Jan
authors: J
authors: Kunstýř
authors: Cardiovascular Anaesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy.
authors: Gianluca
authors: G
authors: Paternoster
authors: Moscow Clinical Regional Research Institute-MONIKI, Moscow, Russia.
authors: Valery
authors: V
authors: Likhvantsev
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Laura
authors: L
authors: Ruggeri
authors: Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Jun
authors: J
authors: Ma
authors: Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria "Mater Domini", Catanzaro, Italy.
authors: Gabriele
authors: G
authors: Alvaro
authors: Mohammed Bin Khalifa Bin Sulman Al-Khalifa Cardiac Center, West Riffa, Bahrain.
authors: Nazar
authors: N
authors: Bukamal
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Giovanni
authors: G
authors: Borghi
authors: Cardiac Anesthesia and Intensive Care, Federal Centre for Cardiac Surgery, Astrakhan, Russia.
authors: Vadim
authors: V
authors: Pasyuga
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Luca
authors: L
authors: Cabrini
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Massimiliano
authors: M
authors: Greco
authors: Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy.
authors: Fabio
authors: F
authors: Guarracino
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Rosalba
authors: R
authors: Lembo
authors: Cardiac Anesthesia and Intensive Care, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors: Rosetta
authors: R
authors: Lobreglio
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Fabrizio
authors: F
authors: Monaco
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Andrea
authors: A
authors: Montisci
authors: Cardioanaesthesia and Intensive Care, Civil Hospital "SS Annunziata", Sassari, Italy.
authors: Giovanni
authors: G
authors: Pala
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Laura
authors: L
authors: Pasin
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Marina
authors: M
authors: Pieri
authors: Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy.
authors: Francesco
authors: F
authors: Santini
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Simona
authors: S
authors: Silvetti
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Massimo
authors: M
authors: Zambon
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Martina
authors: M
authors: Baiardo Redaelli
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Alberto
authors: A
authors: Castella
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Giovanni
authors: G
authors: De Vuono
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Luca
authors: L
authors: Lucchetta
authors: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors: Alberto
authors: A
authors: Zangrillo
authors: Faculty of Medicine, University of Melbourne, Melbourne, Australia.
authors: Rinaldo
authors: R
authors: Bellomo
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D019317:Evidence-Based Medicine / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D038622:Internationality; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data*; D010820:Physicians; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*
keywords: anesthesia; consensus conference; critically ill; intensive care; mortality; survival