Critical care medicine
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Critical care medicine · Oct 2014
Multicenter Study Observational StudyInteraction Between Fluids and Vasoactive Agents on Mortality in Septic Shock: A Multicenter, Observational Study.
Fluids and vasoactive agents are both used to treat septic shock, but little is known about how they interact or the optimal way to administer them. We sought to determine how hospital mortality was influenced by combined use of these two treatments. ⋯ The focus during the first hour of resuscitation for septic shock should be aggressive fluid administration, only thereafter starting vasoactive agents, while continuing aggressive fluid administration. Starting vasoactive agents in the initial hour may be detrimental, and not all of that association is due to less fluids being given with such early initiation of vasoactive agents.
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Critical care medicine · Oct 2014
Comparative StudyEconomic Evaluation of Decompressive Craniectomy Versus Barbiturate Coma for Refractory Intracranial Hypertension Following Traumatic Brain Injury.
Decompressive craniectomy and barbiturate coma are often used as second-tier strategies when intracranial hypertension following severe traumatic brain injury is refractory to first-line treatments. Uncertainty surrounds the decision to choose either treatment option. We investigated which strategy is more economically attractive in this context. ⋯ Based on available evidence, decompressive craniectomy for the treatment of refractory intracranial hypertension following traumatic brain injury provides better value in terms of costs and health gains than barbiturate coma. However, decompressive craniectomy might be less economically attractive for older patients. Further research, particularly on natural history of severe traumatic brain injury patients, is needed to make more informed treatment decisions.