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Highly Accessed Open Badges Letter

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

Thiago Domingos Corrêa, Jukka Takala and Stephan Mathias Jakob*

Author Affiliations

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

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Critical Care 2013, 17:433  doi:10.1186/cc12692

See related commentary by Beloncle et al., and related research by Corrêa et al.,

The electronic version of this article is the complete one and can be found online at:

Published:17 May 2013

© 2013 BioMed Central Ltd


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.


AKI: acute kidney injury; MAP: mean arterial blood pressure.

Competing interests

The authors declare that they have no competing interests.


  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. PubMed Abstract | BioMed Central Full Text OpenURL

  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. PubMed Abstract | BioMed Central Full Text OpenURL