Anesth Analg 2007;104:1603
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000260513.02131.32
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
Dynamic Variables of Fluid Responsiveness may be Related to the Type of Volume Challenge Performed
Cyril Charron, MD,
Christine Fessenmeyer, MD,
Claudine Cosson, PhD,
Jean-Louis Hebert, MD, PhD,
Dan Benhamou, MD,
Jean Xavier Mazoit, MD, PhD, and
Alain Edouard, MD, PhD (Deceased)
Service d’Anesthésie-Réanimation et Unité Propre de Recherche de l’Enseignement Supérieur-Equipe d’Accueil (UPRES-EA 3540); Laboratoire de Biochimie Générale
Laboratoire d’Explorations Fonctionnelles Cardiorespiratoires; Université de Paris Sud, Hôpital de Bicêtre (APHP); Le Kremlin Bicêtre, France; Jean-Xavier.Mazoit{at}kb.u-psud.fr
In Response:
We fully agree with Drs. Renner, Scholtz, and Bein (1) that the volume expansion created by 100 mL of hydroxyethyl starch may be of limited duration. We discussed this in our paper (2). We wanted to avoid any potential harm from using large volumes for fluid expansion. The effects of this limited fluid challenge support our conclusions. The changes in ventilatory settings were done in a random manner and the statistical results are clear. We did not observe any change in left ventricular end diastolic area index. This is the result of the short duration of the effect of starch infusion. However, it is clear from Figure 4 that this small fluid challenge led to a dramatic decrease in the difference between responders and nonresponders both in  % aortic velocity–time integral and in % pulse pressure (Fig. 4). We use thermodilution as suggested by Renner et al. only in very critical situations (3,4).
REFERENCES
- Renner J, Scholz J, Bein B. Dynamic variables of fluid responsiveness may be related to the type of volume challenge performed. Anesth Analg 2007;104:1603.[Free Full Text]
- Charron C, Fessenmeyer C, Cosson C, et al. The influence of tidal volume on the dynamic variables of fluid responsiveness in critically ill patients. Anesth Analg 2006;102:1511–7.[Abstract/Free Full Text]
- Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 2005;294:1664–70.[Abstract/Free Full Text]
- Harvey S, Young D, Brampton W, et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev 2006;3:CD003408.[Medline]
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