Skip to main content
SpringerLink
Log in

Decision Making in the Democracy-based Medicine Era: The Consensus Conference Process

  • Chapter
Reducing Mortality in Critically Ill Patients

Abstract

A large number of randomized controlled trials on critically ill patients has been published in the last years, yielding often opposite or inconclusive findings. To be continuously updated is thus becoming a hard task for physicians, who have to rely on experts’ guidelines to guide their practice. Democracy based medicine is a recently developed method which overcomes the limits of experts’ guidelines. This chapter summarize the consensus process, based on a systematic review, on a formal meeting to discuss and analyze the available evidence and where the consensus statements are produced, and on a dedicated web interface which allows to share intermediate findings gather consensus from colleagues worldwide. This Consensus Conference identified 7 interventions increasing survival and 8 interventions increasing mortality in the critically ill patients. Given the increasing complexity and width of medical literature, the Consensus process is a simple solution to reach a worldwide consensus among pairs on the best published evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vincent J-L (2010) We should abandon randomized controlled trials in the intensive care unit. Crit Care Med 38:S534–S538

    PubMed  Google Scholar 

  2. Ospina-Tascón GA, Büchele GL, Vincent J-L (2008) Multicenter, randomized, controlled trials evaluating mortality in intensive care: doomed to fail? Crit Care Med 36:1311–1322

    PubMed  Google Scholar 

  3. Rotondi AJ, Kvetan V, Carlet J, Sibbald WJ (1997) Consensus conferences in critical care medicine. Methodologies and impact. Crit Care Clin 13:417–439

    CAS  PubMed  Google Scholar 

  4. Bellomo R (2014) The risk and benefits of the consensus process. In: Landoni G, Ruggeri L, Zangrillo A (eds) Reducing mortality in the perioperative period. Springer, Cham

    Google Scholar 

  5. Greco M et al (2014) Democracy-based consensus in medicine. J Cardiothorac Vasc Anesth. doi:10.1053/j.jvca.2014.11.005

    Google Scholar 

  6. Landoni G et al (2011) Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference. Acta Anaesthesiol Scand 55:259–266

    CAS  PubMed  Google Scholar 

  7. Landoni G et al (2012) Randomized evidence for reduction of perioperative mortality. J Cardiothorac Vasc Anesth 26:764–772

    PubMed  Google Scholar 

  8. Landoni G et al (2013) Reducing mortality in acute kidney injury patients: systematic review and international web-based survey. J Cardiothorac Vasc Anesth 27:1384–1398

    PubMed  Google Scholar 

  9. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, Castells L, Vargas V, Soriano G, Guevara M, Ginès P, Rodés J (1999) Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 341:403–409

    CAS  PubMed  Google Scholar 

  10. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371:126–134

    PubMed  Google Scholar 

  11. Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556

    Google Scholar 

  12. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822

    CAS  PubMed  Google Scholar 

  13. Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F (1998) Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med 128:721–728

    CAS  PubMed  Google Scholar 

  14. Plant PK, Owen JL, Elliott MW (2000) Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 355:1931–1935

    CAS  PubMed  Google Scholar 

  15. Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444

    PubMed  Google Scholar 

  16. Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A (2006) Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 173:164–170

    PubMed  Google Scholar 

  17. Collaborating Research Group for Noninvasive Mechanical Ventilation of Chinese Respiratory Society (2005) Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study. Chin Med J (Engl) 118:1589–1594

    Google Scholar 

  18. Ferrer M, Sellarés J, Valencia M, Carrillo A, Gonzalez G, Badia JR, Nicolas JM, Torres A (2009) Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet 374:1082–1088

    PubMed  Google Scholar 

  19. Nava S, Grassi M, Fanfulla F, Domenighetti G, Carlucci A, Perren A, Dell'Orso D, Vitacca M, Ceriana P, Karakurt Z, Clini E (2011) Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomised controlled trial. Age Ageing 40:444–450

    PubMed  Google Scholar 

  20. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L, PROSEVA Study Group (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168

    PubMed  Google Scholar 

  21. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354

    CAS  PubMed  Google Scholar 

  22. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network (2000) N Engl J Med 342:1301–1308

    Google Scholar 

  23. Villar J, Kacmarek RM, Pérez-Méndez L, Aguirre-Jaime A (2006) A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med 34:1311–1318

    PubMed  Google Scholar 

  24. CRASH-2 Trial Collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23–32

    Google Scholar 

  25. Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722

    CAS  PubMed  Google Scholar 

  26. Sloan EP, Koenigsberg M, Gens D, Cipolle M, Runge J, Mallory MN, Rodman G Jr (1999) Diaspirin cross-linked hemoglobin (DCLHb) in the treatment of severe traumatic hemorrhagic shock: a randomized controlled efficacy trial. JAMA 282:1857–1864

    Article  CAS  PubMed  Google Scholar 

  27. Takala J, Ruokonen E, Webster NR, Nielsen MS, Zandstra DF, Vundelinckx G, Hinds CJ (1999) Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med 341:785–792

    CAS  PubMed  Google Scholar 

  28. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ (2009) Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360:1283–1297

    Google Scholar 

  29. Gao Smith F, Perkins GD, Gates S, Young D, McAuley DF, Tunnicliffe W, Khan Z, Lamb SE, BALTI-2 Study Investigators (2012) Effect of intravenous β-2 agonist treatment on clinical outcomes in acute respiratory distress syndrome (BALTI-2): a multicentre, randomised controlled trial. Lancet 379:229–235

    PubMed  Google Scholar 

  30. Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, Madsen KR, Møller MH, Elkjær JM, Poulsen LM, Bendtsen A, Winding R, Steensen M, Berezowicz P, Søe-Jensen P, Bestle M, Strand K, Wiis J, White JO, Thornberg KJ, Quist L, Nielsen J, Andersen LH, Holst LB, Thormar K, Kjældgaard AL, Fabritius ML, Mondrup F, Pott FC, Møller TP, Winkel P, Wetterslev J, 6S Trial Group, Scandinavian Critical Care Trials Group (2012) Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med 367:124–134

    CAS  PubMed  Google Scholar 

  31. Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A, Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, Slutsky AS, Meade MO, OSCILLATE Trial Investigators, Canadian Critical Care Trials Group (2013) High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 368:795–805

    CAS  PubMed  Google Scholar 

  32. Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, Elke G, Berger MM, Day AG, Canadian Critical Care Trials Group (2013) A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med 368:1489–1497

    CAS  PubMed  Google Scholar 

  33. Landoni G, Comis M, Conte M, Finco G, Mucchetti M, Paternoster G et al (2005) Mortality in multicenter critical care trials: an analysis of interventions with a significant effect. Crit Care Med. Mar 27 [Epub ahead of print] PMID: 25821918

    Google Scholar 

  34. Landoni G, Ruggeri L, Zangrillo A (2014) Reducing mortality in the perioperative period. Springer, Cham

    Book  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy

    Massimiliano Greco MD, Marialuisa Azzolini MD & Giacomo Monti MD

Authors
  1. Massimiliano Greco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marialuisa Azzolini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giacomo Monti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimiliano Greco MD .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Intensive care, IRCCS San Raffaele Scientifi c Institute, Milan, Milano, Italy

    Giovanni Landoni

  2. Department of Anesthesia and Intensive care, IRCCS San Raffaele Scientific Institute, Milan, Milano, Italy

    Marta Mucchetti

  3. San Raffaele Hospital, Milan, Italy

    Alberto Zangrillo

  4. Department of Intensive Care, Austin Hospital, Heidelberg, Vic. 3084, Australia

    Rinaldo Bellomo

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Greco, M., Azzolini, M., Monti, G. (2015). Decision Making in the Democracy-based Medicine Era: The Consensus Conference Process. In: Landoni, G., Mucchetti, M., Zangrillo, A., Bellomo, R. (eds) Reducing Mortality in Critically Ill Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-17515-7_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17515-7_1

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17514-0

  • Online ISBN: 978-3-319-17515-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation