Magic Bullets in Cardiac Anesthesia and Intensive Care
- 作者：Giovanni Landoni ; MD ; landoni.giovanni@hsr.it ; Laura Ruggeri ; MD ; Alberto Zangrillo ; MD
- 关键词：anesthesia ; intensive care ; mortality ; survival ; cardiac anesthesia ; magic bullet
- 刊名：Journal of Cardiothoracic and Vascular Anesthesia
- 出版年：2012
- 期刊代码：163_10530770
- 类别：med
- 出版时间：June, 2012
- 卷：26
- 期：3
- 页码：455-458
- 文件大小：145 K
摘要
Even if the first quasi-randomized study in history was published in 1747, there is still a need for evidence-based medicine. In the specific field of cardiac anesthesia, there are few magic bullets (ie, drugs/techniques/strategies that might reduce perioperative mortality), and a recent international consensus conference attempted to list them all. In the absence of evidence-based medicine, medical decisions are made by eminence, experience, or physiopathologic reasoning. Even if increased or decreased mortality could be observed when administering almost every drug used in the current clinical context, if correctly studied, research is slowed by bureaucracy, which, together with ignorance, is indirectly killing thousands of patients per year. Patients should be fully aware of the reduced complication rates and the improved outcomes that occur in patients involved in randomized 鈥渞esearcher-driven鈥?clinical trials, the so-called 鈥淗awthorne effect.鈥?In conclusion, physicians have to do their best although they sometimes have little information. Their ability must counteract the lack of scientific evidences. Caring for critical patients involves making decisions based on realistic tradeoffs of clinical benefit and side effects, but too often these choices are made on the basis of extrapolations and educated guesses.