In Reply

We would like to thank Bloomstoneet al. for their important comments on our study.1 We certainly agree with Bloomstoneet al. that fluid responsiveness should not be confused with hypovolemia. Being a fluid responder does not necessarily mean requiring additional intravenous fluids.Vice versa, fluid responsiveness should be determined before volume expansion, when clinical signs of hypovolemia suggest that patients might require additional intravenous fluids. Identifying hypovolemic patients might be challenging, however, given that standard hemodynamic parameters or biologic markers used during surgery may not be specific enough, or may fail to identify hypovolemic patients in a timely fashion. Furthermore, the majority of studies evaluating the effectiveness of goal-directed fluid therapy on postoperative outcomes, including ours, include protocols that preemptively maximize stroke volume by administering bolus of fluids based on dynamic indices or on the stroke volume response to a fluid challenge, independent of the presence of clinical signs of hypovolemia. As Bloomstoneet al. also reported in their referenced and important consensus statement, stroke volume maximization has been considered “the cornerstone of most goal-directed therapy protocols.”2
Source: Anesthesiology - Category: Anesthesiology Source Type: research