LAUSR

Welcome to the August 2018 issue of Shock. One of the notable attributes of Shock is its combination of both clinical and basic papers addressing important responses in shock, sepsis, ischemia, and inflammation. This month offers a particularly strong interplay between clinical and basic studies, especially as related to cardiovascular system effects. The issues starts with an excellent review article by Geven et al. (1) addressing the effects of adrenomedullin on the vasculature. Adrenomedullin is a small peptide with vasodilator and endothelial-protective properties, but due to its dilator properties can exacerbate hypotension at too high a dose. This review summarizes the biology of adrenomedullin, but more importantly addresses a novel therapeutic strategy. Neutralizing antibodies have long been used to eliminate harmful proteins and peptides, but this group describes the use of a non-neutralizing antibody to stabilize plasma levels of adrenomedullin to enhance its biological effect without the risk of overdose. This information is not only of potential value related to adrenomedullin, but may be an effective strategy for enhancing the beneficial effect of other small peptides. Excessive vasodilation can also be a problem following cardiopulmonary bypass. Lu et al. (2) provide a clinical report on the use of vasopressin as therapy for intractable vasodilation following cardiac surgery in pediatric patients to correct left or right heart anomalies. Seventy consecutive patients were infused with low dose vasopressin and hemodynamic parameters, lactate levels, and urine production monitored. Vasopressin infusion (0.0002 u/kg/min–0.002 u/kg/min) effectively increased blood pressure and total peripheral resistance. More importantly it decreased plasma lactate and increased urine production indicating improved tissue perfusion. The authors conclude that vasopressin at these doses is a safe and effective treatment for hypotension in this patient population. Another clinical paper this month addresses cardiac function associated with heart failure and mechanical cardiac support. Lim and Howell (3) compared blood gas parameters in patients on mechanical cardiac support with acute myocardial infarction with those suffering from end-stage heart failure (ESHF). Their results showed that even with comparable degrees of heart failure, the ESHF patients had a distinct phenotype characterized by a different set of circulatory and metabolic changes. While it is uncertain whether the mechanism of the difference is related to the acute versus chronic nature of the failure, the