In Reply We agree with Dr Rehberg and colleagues that our study demonstrated that selepressin had a number of advantageous physiologic effects on blood pressure, urine output, and other features associated with septic shock.¹ In this way, as the authors suggest, it appears that selepressin shares a set of properties similar to that of other agents used for cardiovascular support in septic shock, including the recently approved angiotensin II.² In contrast to the study on which angiotensin II was approved, we chose a primary outcome designed to determine whether care with selepressin improved downstream patient-centered outcomes, and, at least in this setting, we were unable to demonstrate any such improvement. That said, we were reassured that there was no obvious sign that care with selepressin was associated with more adverse events than care with norepinephrine alone. Rehberg and colleagues note there are limited data suggesting that any vasopressor improves downstream patient-centered outcomes compared with any other and therefore imply that if selepressin appears to work as well as other vasopressors, surely it should be added to the armamentarium of vasopressors for the care of septic shock, or at least be available for further evaluation. This line of reasoning represents one side of an old argument, namely, is there value in providing clinicians with a larger number of agents with clinically similar effects? Rehberg and colleagues, at least in this instance, seem to think so, and either way, we agree this is an important question to consider.

在答复中，我们同意Rehberg博士及其同事的观点，即我们的研究表明硒素对血压，尿量以及与败血性休克相关的其他特征具有许多有益的生理作用。^[1]这样，正如作者所建议的那样，硒素似乎具有与其他用于败血性休克心血管支持的药物相似的特性，包括最近批准的血管紧张素II。²与批准血管紧张素II的研究相反，我们选择了一项主要结局，旨在确定以硒加压素治疗能否改善以患者为中心的下游结局，至少在这种情况下，我们无法证明有任何这种改善。就是说，我们可以放心的是，与仅使用去甲肾上腺素治疗相比，没有明显的迹象表明，使用硒代加压素治疗与更多不良事件相关。Rehberg及其同事指出，仅有有限的数据表明，任何升压药都比其他任何升压药都能改善下游以患者为中心的结局，因此暗示，如果selelepressin看起来像其他升压药一样有效，那么肯定应将其添加到升压药的药库中进行护理感染性休克的症状，或至少可以作进一步评估。这条推理路线代表了一个古老论点的一面，即为临床医生提供更多具有临床相似作用的药物是否有价值？Rehberg和同事，至少在这种情况下，似乎是这样认为的，无论哪种方式，我们都同意这是一个需要考虑的重要问题。