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  • Letter
  • Open Access

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

  • 1,
  • 1 and
  • 1Email author
Critical Care201317:433

  • Published:


  • Acute Kidney Injury
  • Dilution Effect
  • Mean Arterial Blood Pressure
  • Target Blood Pressure
  • Circulate Blood Volume

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.



acute kidney injury


mean arterial blood pressure.


Authors’ Affiliations

Department of Intensive Care Medicine, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 10, Bern, CH-3010, Switzerland


  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. 10.1186/cc12543PubMed CentralView ArticlePubMedGoogle Scholar
  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. 10.1186/cc12495PubMed CentralView ArticlePubMedGoogle Scholar


© BioMed Central Ltd 2013