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

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.

References

  1. 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/cc12543

    PubMed Central  Article  PubMed  Google Scholar 

  2. 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/cc12495

    PubMed Central  Article  PubMed  Google Scholar 

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Correspondence to Stephan Mathias Jakob.

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The authors declare that they have no competing interests.

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Corrêa, T.D., Takala, J. & Jakob, S.M. Target blood pressure in sepsis: between a rock and a hard place. Crit Care 17, 433 (2013). https://doi.org/10.1186/cc12692

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Keywords

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