We read with interest the article by Dr. Bernstein on Pressure Pulse Contour-derived Stroke Volume and Cardiac Output in the Morbidly Obese Patient [1]. It is important to discuss the data presented in the review, considering that caution is necessary to accept his conclusion on pressure recording analytical method (PRAM) [2]. We wonder how it is possible to draw similar conclusions based on the small number of studies considered and patients enrolled [3–5].We may also highlight some discrepancies not only between the studies considered but also within each study [3–5]. It is important to distinguish between hemodynamic data measured directly, such as mean arterial pressure (MAP) or heart rate (HR), and hemodynamic data calculated by the PRAM [6–11] or other methods [12]. From an analysis of MAP and HR in reviewed studies, we can observe how [3–5] these values present different trends compared with our results (Table 1). Stroke volume (SV) of our patients [1], calculated from stroke volume index (SVI), according to the formula SV= SVI×BSA (Mosteller-derived), is similar to the data of Dumont et al. [4] until MAP and HR do not diverge from ours, while the data of Nguyen et al. [5] and Artuso et al. [3] are different from ours [1] and similar between themselves, as shown on Table 1 (we prefer to analyze stroke volume instead of cardiac index because the latter is directly related to heart rate). Our systemic vascular resistance (SVR), calculated from systemic vascular resistance index (SVRI) according to the formula SVR=SVRI/BSA, is very different from Nguyen et al. [5] and Artuso et al. [3] and slightly different from Dumont et al. [4] (Table 1)

Response to Dr. Bernstein's review: pressure pulse contour-derived stroke volume and cardiac output in the morbidly obese patient.

FORFORI, FRANCESCO;GIUNTA, FRANCESCO
2009

Abstract

We read with interest the article by Dr. Bernstein on Pressure Pulse Contour-derived Stroke Volume and Cardiac Output in the Morbidly Obese Patient [1]. It is important to discuss the data presented in the review, considering that caution is necessary to accept his conclusion on pressure recording analytical method (PRAM) [2]. We wonder how it is possible to draw similar conclusions based on the small number of studies considered and patients enrolled [3–5].We may also highlight some discrepancies not only between the studies considered but also within each study [3–5]. It is important to distinguish between hemodynamic data measured directly, such as mean arterial pressure (MAP) or heart rate (HR), and hemodynamic data calculated by the PRAM [6–11] or other methods [12]. From an analysis of MAP and HR in reviewed studies, we can observe how [3–5] these values present different trends compared with our results (Table 1). Stroke volume (SV) of our patients [1], calculated from stroke volume index (SVI), according to the formula SV= SVI×BSA (Mosteller-derived), is similar to the data of Dumont et al. [4] until MAP and HR do not diverge from ours, while the data of Nguyen et al. [5] and Artuso et al. [3] are different from ours [1] and similar between themselves, as shown on Table 1 (we prefer to analyze stroke volume instead of cardiac index because the latter is directly related to heart rate). Our systemic vascular resistance (SVR), calculated from systemic vascular resistance index (SVRI) according to the formula SVR=SVRI/BSA, is very different from Nguyen et al. [5] and Artuso et al. [3] and slightly different from Dumont et al. [4] (Table 1)
Forfori, Francesco; Romano, Sm; Balderi, T; Anselmino, M; Giunta, Francesco
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/201277
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