Target blood pressure in sepsis: between a rock and a hard place

  • Thiago Domingos Corrêa1,

    Affiliated with

    • Jukka Takala1 and

      Affiliated with

      • Stephan Mathias Jakob1Email author

        Affiliated with

        Critical Care201317:433

        DOI: 10.1186/cc12692

        Published: 17 May 2013

        We acknowledge the constructive comments of Beloncle and colleagues [1] regarding our recently published study. We demonstrated that targeting a mean arterial blood pressure (MAP) between 50 and 60 mmHg (Low-MAP) in porcine fecal peritonitis was associated with increased incidence of acute kidney injury (AKI) in comparison to targeting a MAP between 75 and 85 mmHg (High-MAP), which resulted in increased net positive fluid balance and vasopressor load [2].

        Beloncle and colleagues argue that a dilution effect of the higher amount of fluid resuscitation on creatinine concentrations cannot be ruled out. Nevertheless, we report total hemoglobin concentrations in our manuscript [1], and, at study end, they were actually higher in animals in the High-MAP group than in the Low-MAP group (10.0 g/dl versus 8.4 g/dl, respectively, P = 0.008; Table 3 in the original manuscript). The assumption that the low incidence of AKI in animals allocated to the High-MAP group could be explained by a dilution effect is, therefore, unlikely [2]. We hypothesize that the circulating blood volume in the High-MAP group was lower at study end as a consequence of norepinephrine-induced vasoconstriction.

        Moreover, Beloncle and colleagues suspect that low baseline hemoglobin levels in the Low-MAP group may have contributed to the development of kidney dysfunction [2]. Nevertheless, since the values were virtually identical in the Low- and High-MAP groups (9.3 mg/dl and 9.2 mg/dl, respectively), it seems unlikely that low hemoglobin levels - which were normal for young pigs - explain the observed differences in AKI.

        Abbreviations

        AKI: 

        acute kidney injury

        MAP: 

        mean arterial blood pressure.

        Declarations

        Authors’ Affiliations

        (1)
        Department of Intensive Care Medicine, Inselspital, Bern University Hospital and University of Bern

        References

        1. Beloncle F, Lerolle N, Radermacher P, Asfar P: Target blood pressure in sepsis: between a rock and a hard place. Crit Care 2013, 17:126.PubMedView Article
        2. Corrêa TD, Vuda M, Takala J, Djafarzadeh S, Silva E, Jakob SM: Increasing mean arterial blood pressure in sepsis: effects on fluid balance, vasopressor load and renal function. Crit Care 2013, 17:R21.PubMedView Article

        Copyright

        © BioMed Central Ltd 2013

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