Target blood pressure in sepsis: between a rock and a hard place
© BioMed Central Ltd 2013
Published: 17 May 2013
We acknowledge the constructive comments of Beloncle and colleagues  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 .
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 , 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 . 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 . 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.
acute kidney injury
mean arterial blood pressure.
- 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. 10.1186/cc12543PubMed CentralView ArticlePubMed
- 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. 10.1186/cc12495PubMed CentralView ArticlePubMed