In Reply

Drs. Fan and Faraday write with concerns about the Vasopressin and Cardiac Surgery Trial1 and my editorial2; I agree with some, but not all, of their points. My first point of agreement is the criticism that clinical treatment was not protocolized; however, in most randomized controlled trials, nonrandomized care is most often not protocolized for simple logistical reasons. The point is that nonprotocolized care was used in both masked arms of the Vasopressin and Cardiac Surgery Trial. Greater use of dobutamine in the norepinephrine group in the Vasopressin and Cardiac Surgery Trial could have been because vasopressin had less negative inotropic effects than norepinephrine, as vasopressin has some vasodilation action due to release of nitric oxide.3,4
Source: Anesthesiology - Category: Anesthesiology Source Type: research