We thank Drs. Beavan and Clift for their comments. They suggest that passive-leg-rising (PLR) be used to evaluate fluid responsiveness in a spontaneous breathing patient as stroke volume variation (SVV) has only been fully validated in mechanically-ventilated patients. In the case described there were various problems: the patient refused blood transfusion and the issue was to balance fluid administration, oxygen delivery and consumption and hemodilution. As a result, in addition to SVV, we used cardiac index, stroke volume and the calculated oxygen delivery to guide our interventions. We looked at trends of these values rather than isolated numbers and believe this to be a useful approach.
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Published online: September 12, 2011
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.