• Antonio Pisano, Giovanni Landoni, Vladimir Lomivorotov, Marco Comis, Gordana Gazivoda, Massimiliano Conte, Ludhmila Hajjar, Gabriele Finco, Miomir Jovic, Marta Mucchetti, Jan Kunstýř, Gianluca Paternoster, Valery Likhvantsev, Laura Ruggeri, Jun Ma, Gabriele Alvaro, Nazar Bukamal, Giovanni Borghi, Vadim Pasyuga, Luca Cabrini, Massimiliano Greco, Fabio Guarracino, Rosalba Lembo, Rosetta Lobreglio, Fabrizio Monaco, Andrea Montisci, Giovanni Pala, Laura Pasin, Marina Pieri, Francesco Santini, Simona Silvetti, Massimo Zambon, Martina Baiardo Redaelli, Alberto Castella, Giovanni De Vuono, Luca Lucchetta, Alberto Zangrillo, and Rinaldo Bellomo.
• Division of Cardiac Anesthesia and Intensive Care, AORN "Dei Colli", Monaldi Hospital, Naples, Italy.
• J. Cardiothorac. Vasc. Anesth. 2016 Oct 1; 30 (5): 1386-95.

ObjectivesDemocracy-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.Design And SettingA systematic review of literature followed by web-based voting on findings of a consensus conference.ParticipantsA total of 555 clinicians from 61 countries.InterventionsThe 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.Measurements And Main ResultsAccording 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.ConclusionsPhysicians' 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.Copyright © 2016 Elsevier Inc. All rights reserved.

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