LAUSR

Owing to the high quality and clinical relevance of the manuscripts included in the November 2018 issue of SHOCK, writing this commentary was really inspiring, and we therefore wish to thank the editors for giving us this opportunity. In the first article, Izquierdo-Garcia et al. (1) used nuclear magnetic resonance (NMR) spectroscopy to investigate the metabolomic profile of acute respiratory distress syndrome (ARDS) in patients with H1N1 influenza virus-related pneumonia. In this clinical study, the authors found that the metabolomic profile in the serum can help to identify the presence of ARDS, and they concluded that NMR spectroscopy might represent an interesting method for identifying specific biomarkers in patients with ARDS. In a second clinical study, this time including 227 patients, Vassiliou et al. (2) analyzed the impact of high and low vitamin D levels at the time of hospital admission on the clinical course observed in nonseptic critically ill patients. In general, a high prevalence of low vitamin D levels was found among these patients. In the patients with markedly depressed vitamin D levels, a higher rate of respiratory tract infections was observed. However, the vitamin D levels showed no correlation with mortality, septic complications, or the duration of the intensive care unit (ICU) stay. Therefore, it was postulated that further studies should focus on the potentially beneficial effects of vitamin D substitution in relation to respiratory infection rates and sepsis in critically ill patients. Cheng et al. (3) focused on the treatment of postoperative vasoplegic shock following cardiac surgery. By comparing the effects of vasopressin or norepinephrine treatment in 1156 patients, they found that vasopressin did not improve the primary and secondary outcome parameters, whereas the application of norepinephrine was associated with a higher cardiac index, lower lactate levels, and less dopamine use. Based on their results, the authors concluded that the application of vasopressin did not improve the postoperative outcomes in patients with preoperative left ventricular dysfunction when compared to norepinephrine. Norepinephrine was therefore recommended to be considered as the first-line vasopressor because of its superior effects on postoperative recovery. The early C-reactive protein (CRP) levels were measured from the point of hospital discharge for a total of 6 weeks in a study conducted by Grander et al. (4). The CRP levels of patients without either adverse events or rehospitalization