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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References
- Clinical evaluation of the Flotrac/Vigileo system for continuous cardiac output monitoring in patients undergoing regional anesthesia for elective cesarean section: a pilot study.Clinics (Sao Paulo). 2010; 65: 793-798
- Maternal hemodynamic monitoring in obstetric anesthesia.Anesthesiology. 2008; 109: 765-767
- Maternal hemodynamic monitoring and the Vigileo monitor.Anesthesiology. 2009; 111: 211-212
Article info
Publication history
Published online: September 12, 2011
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© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
