Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

The comparative effectiveness of vasopressors, inotropes, and volume in the management of septicemia with hypotension. Population: patients with septicemia and hypotension Intervention/Comparators: vasopressors (e.g. dopamine, ephedrine, epinephrine, levarterenol, mephentermine, metaraminol, methoxamine, phenylephrine) , ionotropes (e.g. dobutamine, isoproterenol) Outcomes: volume replacement, patient survival

Population: patients with septicemia and hypotension Intervetion/Comparators: amount of intervenous volume support initially and over several days Outcomes: patient survival

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Intervention/Comparators: vasopressors (e.g. dopamine, ephedrine, epinephrine, levarterenol, mephentermine, metaraminol, methoxamine, phenylephrine) , ionotropes (e.g. dobutamine, isoproterenol)

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Population: patients with septicemia and hypotension

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

stratify by etiologic agent, antimicrobial therapy, co morbidities

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

improvements in mortality others

Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Infectious diseases, including HIV/AIDS

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

Pharmacotherapy directed specifically against hypotension and shock is frequently employed to preserve life and vital organ function until control of the infectious process allows homeostasis to be reestablished.The appropriate choice and role of vasoactive agents—pressors and inotropes is unclear.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

no answer

Please tell us how you heard about the Effective Health Care Program