CHEST Guidelines-Response_chest

Response_chest_15 (2)
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The correspondence centers on a discussion regarding the role of serum calcium levels in refractory vasodilatory shock and potential treatments involving calcium infusion. The initial letter, penned by Salvatore Minisola and colleagues, references a review article by Jentzer et al., which discusses the management of refractory vasodilatory shock. The authors of the letter express interest in the etiology of hypocalcemia in vasodilatory shock, questioning its role as a causative factor. They suggest that hypocalcemia might be an epiphenomenon rather than a pathogenetic mechanism for vasodilatory shock, which remains uncertain due to limited evidence supporting the safety and efficacy of calcium infusion as a rescue therapy.<br /><br />Minisola and colleagues back their perspective with cases showing the reversal of hypocalcemic cardiomyopathy when calcium levels are normalized. They emphasize calcium's pivotal role in muscle contraction and call for further studies to elucidate the role of low serum calcium in vasodilatory shock.<br /><br />In response, Jentzer and his team acknowledge the importance of the comments highlighting the complexities surrounding calcium's role in refractory shock. They point out that while low ionized calcium levels are linked with adverse outcomes, a cause-and-effect relationship with vasodilatory shock remains unestablished. They underscore the potential of calcium infusion to mitigate hypotension but note that current evidence is insufficient to guide routine clinical application, advocating for more research to validate any therapeutic benefits.<br /><br />Additionally, the submission discusses a separate study by Serafi et al. comparing qSOFA and SIRS criteria for sepsis detection, where SIRS criteria excel in diagnosing sepsis, and qSOFA slightly edges out in predicting hospital mortality. Proposing combined criteria use could enhance therapeutic interventions, but the study notes a lack of detailed methodology for result replication.
Keywords
serum calcium
vasodilatory shock
calcium infusion
hypocalcemia
cardiomyopathy
muscle contraction
ionized calcium
sepsis detection
qSOFA
SIRS criteria