• Chiara Sartini, Vladimir Lomivorotov, Antonio Pisano, Hynek Riha, Martina Baiardo Redaelli, Juan Carlos Lopez-Delgado, Marina Pieri, Ludhmila Hajjar, Evgeny Fominskiy, Valery Likhvantsev, Luca Cabrini, Nikola Bradic, Daniele Avancini, Chew Yin Wang, Rosalba Lembo, Maxim Novikov, Gianluca Paternoster, Gordana Gazivoda, Gabriele Alvaro, Agostino Roasio, Chengbin Wang, Luca Severi, Laura Pasin, Paolo Mura, Mario Musu, Simona Silvetti, Carmine Domenico Votta, Alessandro Belletti, Francesco Corradi, Claudia Brusasco, Simona Tamà, Laura Ruggeri, Chow-Yen Yong, Daniela Pasero, Giuseppe Mancino, Savino Spadaro, Massimiliano Conte, Rosetta Lobreglio, Diana Di Fraja, Emanuela Saporito, Alessandro D'Amico, Salvatore Sardo, Alessandro Ortalda, Andrey Yavorovskiy, Claudio Riefolo, Fabrizio Monaco, Rinaldo Bellomo, Alberto Zangrillo, and Giovanni Landoni.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• J. Cardiothorac. Vasc. Anesth. 2019 Oct 1; 33 (10): 2685-2694.

ObjectiveReducing mortality is a key target in critical care and perioperative medicine. The authors aimed to identify all nonsurgical interventions (drugs, techniques, strategies) shown by randomized trials to increase mortality in these clinical settings.DesignA systematic review of the literature followed by a consensus-based voting process.SettingA web-based international consensus conference.ParticipantsTwo hundred fifty-one physicians from 46 countries.InterventionsThe authors performed a systematic literature search and identified all randomized controlled trials (RCTs) showing a significant increase in unadjusted landmark mortality among surgical or critically ill patients. The authors reviewed such studies during a meeting by a core group of experts. Studies selected after such review advanced to web-based voting by clinicians in relation to agreement, clinical practice, and willingness to include each intervention in international guidelines.Measurements And Main ResultsThe authors selected 12 RCTs dealing with 12 interventions increasing mortality: diaspirin-crosslinked hemoglobin (92% of agreement among web voters), overfeeding, nitric oxide synthase inhibitor in septic shock, human growth hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute respiratory distress syndrome, plasma-derived protein C concentrate, aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in meningitis, methylprednisolone in traumatic brain injury, and albumin in traumatic brain injury (72% of agreement). Overall, a high consistency (ranging from 80% to 90%) between agreement and clinical practice was observed.ConclusionThe authors identified 12 clinical interventions showing increased mortality supported by randomized controlled trials with nonconflicting evidence, and wide agreement upon clinicians on a global scale.Copyright © 2019 Elsevier Inc. All rights reserved.

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