Correspondence  |   March 2018
In Reply
Author Notes
  • Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada (G.B.). gabriele.baldini@mcgill.ca
  • (Accepted for publication November 27, 2017.)
    (Accepted for publication November 27, 2017.)×
Article Information
Correspondence
Correspondence   |   March 2018
In Reply
Anesthesiology 3 2018, Vol.128, 683-685. doi:10.1097/ALN.0000000000002051
Anesthesiology 3 2018, Vol.128, 683-685. doi:10.1097/ALN.0000000000002051
We would like to thank Bloomstone et al. for their important comments on our study.1  We certainly agree with Bloomstone et 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 Bloomstone et 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 
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