Nonsurgical strategies to reduce mortality in patients undergoing cardiac surgery: An updated consensus process
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info:eu-repo/semantics/openAccessTarih
2018Yazar
Landoni, GiovanniLomivorotov, Vladimir
Silvietti, Simona
Neto, Caetanor Nigro
Pisano, Antonio
Alvaro, Gabriele
Hajjar, Ludmilla Abrahao
Paternoster, Gianluca
Riha, Hynek
Monaco, Fabrizio
Szekely, Andrea
Lembo, Rosalba
Aslan, Nesrin A.
Affronti, Giovanni
Likhvantsev, Valery
Amarelli, Cristiano
Fominskiy, Evgeny
Redaelli, Martina Baiardo
Putzu, Alessandro
Baiocchi, Massimo
Ma, Jun
Bono, Giuseppe
Camarda, Valentina
Covello, Remo Daniel
Di Tomasso, Nora
Labonia, Miriam
Leggieri, Carlo
Lobreglio, Rosetta
Monti, Giacomo
Mura, Paolo
Scandroglio, Anna Mara
Pasero, Daniela
Turi, Stefano
Roasio, Agostino
Votta, Carmine D.
Saporito, Emanuela
Riefolo, Claudio
Sartini, Chiara
Brazzi, Luca
Bellomo, Rinaldo
Zangrillo, Alberto
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Landoni, G., Lomivorotov, V., Silvietti, S., Neto, C. N., Pisano, A., Alvaro, G. ... Zangrillo, A. (2018). Nonsurgical strategies to reduce mortality in patients undergoing cardiac surgery: An updated consensus process. Journal of Cardiothoracic and Vascular Anesthesia, 32(1), 225-235. https://dx.doi.org/10.1053/j.jvca.2017.06.017Özet
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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Journal of Cardiothoracic and Vascular AnesthesiaCilt
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