Selepressin for Patients With Septic Shock —Reply

In Reply We agree with Dr Rehberg and colleagues that our study demonstrated that selepressin had a number of advantageous physiologic effects on blood pressure, urine output, and other features associated with septic shock. In this way, as the authors suggest, it appears that selepressin shares a set of properties similar to that of other agents used for cardiovascular support in septic shock, including the recently approved angiotensin II. In contrast to the study on which angiotensin II was approved, we chose a primary outcome designed to determine whether care with selepressin improved downstream patient-centered outcomes, and, at least in this setting, we were unable to demonstrate any such improvement. That said, we were reassured that there was no obvious sign that care with selepressin was associated with more adverse events than care with norepinephrine alone. Rehberg and colleagues note there are limited data suggesting that any vasopressor improves downstream patient-centered outcomes compared with any other and therefore imply that if selepressin appears to work as well as other vasopressors, surely it should be added to the armamentarium of vasopressors for the care of septic shock, or at least be available for further evaluation. This line of reasoning represents one side of an old argument, namely, is there value in providing clinicians with a larger number of agents with clinically similar effects? Rehberg and colleagues, at least in this instance, seem to thi...
Source: JAMA - Category: General Medicine Source Type: research