CHEST Guidelines-Response_chest

Response_chest_15 (3)

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The correspondence between Dr. Salvatore Minisola and Dr. Jacob C. Jentzer in the CHEST journal explores the role of ionized hypocalcemia in refractory vasodilatory shock, an area with limited evidence and much debate. Dr. Minisola raises concerns that hypocalcemia's influence on vasodilatory shock is not thoroughly addressed and suggests that reduced serum calcium might play a pathogenetic role. He refers to cases of hypocalcemic cardiomyopathy, which reverse upon calcium level correction, emphasizing calcium's known physiological importance in muscle contraction. Dr. Jentzer acknowledges these insights, agreeing more research is necessary to determine whether hypocalcemia is a contributing factor or merely an associated phenomenon in refractory shock. Jentzer also highlights the potential for calcium correction to mitigate hypotension and cardiac dysfunction in critically ill patients. However, the efficacy and safety of calcium infusion for managing such conditions remain under-explored, necessitating further investigation.<br /><br />In another article review response, an author comments on a systematic review by Serafim et al., comparing qSOFA and SIRS criteria for sepsis outside the ICU. The review concluded SIRS criteria performed better than qSOFA for diagnosing sepsis, while qSOFA was slightly better at predicting hospital mortality. The author questions the search strategy transparency, suggesting that combining both criteria could enhance therapeutic decisions but urges clarity for replication and detailed methodology to validate findings.<br /><br />Both responses underscore the importance of further studies and clear reporting methodologies in medical research, as these areas significantly impact clinical practice and treatment protocols in critical care.

Keywords

ionized hypocalcemia

vasodilatory shock

hypocalcemic cardiomyopathy

serum calcium

muscle contraction

qSOFA

SIRS criteria

sepsis

calcium infusion

critical care