Correspondence  |   January 2018
In Reply
Author Notes
  • InCor, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo (L.A.H.). ludhmila@usp.br
  • (Accepted for publication September 27, 2017.)
    (Accepted for publication September 27, 2017.)×
Article Information
Correspondence
Correspondence   |   January 2018
In Reply
Anesthesiology 1 2018, Vol.128, 231-233. doi:10.1097/ALN.0000000000001958
Anesthesiology 1 2018, Vol.128, 231-233. doi:10.1097/ALN.0000000000001958
We appreciate the comments from Dr. Jha. According to the study protocol, all patients received a cardiac output monitor aiming to optimize fluid status and cardiac index. Therefore, as our data show, with norepinephrine or vasopressin, we did not observe either a reduction in the cardiac index or a worsening of tissue perfusion and oxygenation parameters as lactate and central venous oxygen saturation.1  Furthermore, the incidence of low cardiac output and cardiogenic shock in the norepinephrine and vasopressin groups was not different. We attribute this to the fact that we assessed the fluid status and used inotropes regularly, in accordance with an established protocol of care. Dobutamine is our inotrope of choice in vasoplegic syndrome because both levosimendan and milrinone have inherent vasodilating properties that result in hypotension in these cases. In the Vasopressin and Septic Shock Trial (VASST) substudy, Gordon et al. showed similar effects of both vasopressin and norepinephrine in septic shock patients in hemodynamic and cardiovascular biomarkers.2  We postulate that vasopressin is as safe as norepinephrine in terms of cardiovascular effects in this group of patients, because we correct hypotension early and adequately monitor these patients in anticipation of inotropes needing a correction in fluid deficit.
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