Newly Published
Correspondence  |   September 2019
Preload Dependence and Microcirculation Relationship: Reply
Author Notes
  • Department of Anaesthesia and Intensive Care, University Hospitals of Paris-Sud, Paris, France. jacques.duranteau@aphp.fr
  • (Accepted for publication August 27, 2019.)
    (Accepted for publication August 27, 2019.)×
Article Information
Correspondence
Correspondence   |   September 2019
Preload Dependence and Microcirculation Relationship: Reply
Anesthesiology Newly Published on September 24, 2019. doi:10.1097/ALN.0000000000002996
Anesthesiology Newly Published on September 24, 2019. doi:10.1097/ALN.0000000000002996
I would like to thank the authors of the letter for reminding us that the notion of preload dependence is not synonymous with hypovolemia. As mentioned in the article,1  preload dependence is defined as a state in which increases in right ventricular and/or left ventricular end-diastolic volume result in an increase in stroke volume.2  Changes in preload could be due to hypovolemia and/or a decrease in venous tone with increased venous capacity. Having a preload dependence does not give any indication of the state of the microcirculation. Indeed, microcirculation can be preserved up to a certain level of venous return decline, but can then be altered if the venous return decline is greater. For this reason, it is essential to have an assessment of microcirculation in order to titrate perioperative fluid and correctly administrate vasopressors.