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Respondents as well as participants in other surveys are familiar with decompressive laparotomy and more or less perform this escalated therapy option partly in combination with open-abdomen management often (Table 1).
This approach seems to have much merit as it allows standard or escalated therapy to be introduced according to response.
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However, several publications report on targets and timelines that were used as thresholds before escalating therapy.
However, most Thai families prefer not to escalate therapy including CPR.
Around 20% were not ready to make a decision, but finally agreed not to escalate therapy.
In a futile case scenario, Do Not Escalate Therapy was the preferred response (54.7%).
Myocardial depression with β-blockers could explain the need to escalate therapy with vasoactive drugs in the current series.
Two approaches to escalating therapy were employed (criteria-based or disease activity score in 28 joints (DAS28 -based).
This was an elderly patient with cryptogenic cirrhosis and multiple organ failure in whom a decision was made not to escalate therapy.
In the urgent clinical setting, the decision to escalate therapy should be made as part of a multidisciplinary discussion involving the interventionist and the primary medical team.
The rationale behind escalating therapy is that treatment starts with safe drugs and only moves on to more aggressive ones if the ongoing treatment fails.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com