? Arginine vasopressin (AVP) infusion in septic shock may be less effective when endogenous AVP plasma selleck compound levels are high.? In ovine septic shock, selective V2-receptor-antagonism supplemented with open-label norepinephrine stabilized cardiovascular hemodynamics as effectively as combined AVP and open-label norepinephrine.? Selective V2-receptor-antagonism attenuated metabolic, liver, and renal dysfunction as compared with AVP and placebo therapy in ovine septic shock.? Selective V2-receptor-antagonism might represent a useful therapeutic option in septic shock under conditions with high endogenous AVP plasma levels.AbbreviationsAVP: arginine vasopressin; BL: baseline; ELISA: enzyme-linked immunosorbent assay; LVSWI: left ventricular stroke work index; MAP: mean arterial pressure; ST: shock time; V1aR/V2R: V1a/V2 receptor; VASST: Vasopressin and Septic Shock Trial.

Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsSR designed and performed the experiment, summarized and analyzed the data, and wrote the manuscript. CE designed and performed the experiment, summarized and analyzed the data, and edited the manuscript. MW and AM designed the experiment, analyzed the data, and edited the manuscript. ML, EW, MD, HVA, and DLT analyzed the data and edited the manuscript. A-KS, EL, and TGK performed the experiment and summarized the data. All authors read and approved the final manuscript.Supplementary MaterialAdditional file 1:Supplemental Digital Content. Additional information on the methods and procedures applied in the present study [31-33].

Click here for file(41K, DOC)NotesSee related commentary by Landry and Oliver, http://ccforum.com/content/14/6/1011AcknowledgementsThe authors thank Mareike Schneider, a medical student from the Department of Anesthesiology and Intensive Care at the University of Muenster (Muenster, Germany), for expert technical assistance during the study. This work was supported only by intramural funding of the University of Muenster.
International guidelines suggest the use of non-invasive continuous positive airways pressure (CPAP) as first-line intervention in patients with acute cardiogenic pulmonary edema (ACPE) [1]. CPAP has proven to be easier to use, quicker to implement in clinical practice and to carry smaller associated costs in comparison with non-invasive ventilation (NIV) [2].

In light of these findings, CPAP has also been also used to treat ACPE patients outside the intensive care unit or the Emergency Department, as in the general ward or during prehospital care [3].The rate of mortality in ACPE patients treated with CPAP is reported to be up to 13% [4,5]. Therefore, it is crucial for healthcare providers to identify risk factors for Drug_discovery failure of CPAP treatment, in order to better allocate medical resources and improve clinical outcomes of ACPE patients.