Fluids, Vasopressors, and Inotropes to Restore Heart–Vessel Coupling in Sepsis: Treatment Options and Perspectives

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors

The current review aimed to present and discuss the typical pathophysiologic problems in the early management of hemodynamic derangement induced by sepsis and the latest findings about the treatments currently used for hemodynamic support in patients with septic shock and their role in restoring adequate peripheral perfusion. This is a good point however the main treatment of septic shock is the antibiotics which are not mentioned at all in the review. Also, I have some comments such as:

-          Abstract is too short, and vague and needs more clarification.

-          Many facts are mentioned without citing the reference.

-          Other comments in the manuscript file

 

Best regards

Comments for author File: Comments.pdf

Author Response

The current review aimed to present and discuss the typical pathophysiologic problems in the early management of hemodynamic derangement induced by sepsis and the latest findings about the treatments currently used for hemodynamic support in patients with septic shock and their role in restoring adequate peripheral perfusion. This is a good point however the main treatment of septic shock is the antibiotics which are not mentioned at all in the review.

 

Reply: we thank for your appreciation. We decided to focus on the treatment aimed at hemodynamic stabilization. We only mentioned the antibiotic treatment in the introduction, but an exhaustive description of their use deserves a separate review.  

 

Also, I have some comments such as:

-          Abstract is too short, and vague and needs more clarification.

Reply: we thank for the suggestion and we modified it.

-          Many facts are mentioned without citing the reference.

Reply: we apologize for the lacking references and we added them.

-          Other comments in the manuscript file

Reply: we thank for your suggestions and we responded point-to-point to your comments in the PDF file. We also modified the manuscript based on your comments.

Reviewer 2 Report

Comments and Suggestions for Authors

One merit of the paper is in detaled examination of pro and contra  for current strategies of a hemodynamics support with fluids in critical patients. Another merit is a contemporary analysis of  vasopressins timing and dosage use in patients with sepsis/sepsis shock. In addition, paper provides useful evidence on inotropic use based on pathophysiology of critical illness. All the information seems useful for anestesiologists and critical care doctors and nurses because it provides a logic path from the need to employ the life-saving procedure to mechanisms of the illness development and technology of the use. A drawback of the review of the review includes limited discussion on vasopressors (noradrenalin and vasopressin) although there are a plenty of recent data on angiotensin II as an additional vasopressor when and if needed (in cases of non-effectivity/resistance to both vasopressors used previously). This strategy may be critically discussed (at least, briefly ) "to complete the picture".

Author Response

One merit of the paper is in detaled examination of pro and contra  for current strategies of a hemodynamics support with fluids in critical patients. Another merit is a contemporary analysis of  vasopressins timing and dosage use in patients with sepsis/sepsis shock. In addition, paper provides useful evidence on inotropic use based on pathophysiology of critical illness. All the information seems useful for anestesiologists and critical care doctors and nurses because it provides a logic path from the need to employ the life-saving procedure to mechanisms of the illness development and technology of the use. A drawback of the review of the review includes limited discussion on vasopressors (noradrenalin and vasopressin) although there are a plenty of recent data on angiotensin II as an additional vasopressor when and if needed (in cases of non-effectivity/resistance to both vasopressors used previously). This strategy may be critically discussed (at least, briefly ) "to complete the picture".

Reply: we thank for the suggestion and we added a paragraph about non-conventional vasopressors, including epinephrine and Angiotensin II.