In Reply:—
I read with interest the comments by Bendjelid and Suter regarding our article entitled “Early Preload Adaptation in Septic Shock? A Transesophageal Echocardiographic Study.”1
As we stated in this study, measurements by transesophageal echocardiography underestimated end-diastolic left ventricular volume. Comparing this method with the conventional transesophageal echocardiographic approach, we have observed an average underestimation of 12%. Therefore, even with this underestimation, left ventricular end-diastolic volume was in the normal range in the septic patients in our study. This finding was corroborated by a simultaneously normal value for left ventricular end-diastolic area in the short axis.
Retrospective calculation performed by Bendjelid and Suter showed a low systemic vascular resistance index in the patients in our study. This finding is expected in sepsis. However, they should have performed this calculation for the three subgroups described in the study, not only for the whole group. Particularly, in hypokinetic (and nondilated) patients, the average systemic vascular resistance index calculated by their formula was 2,089 dyn · s · cm−5· m−2, rendering their argumentation irrelevant.
Finally, Bendjelid and Suter concluded that the patients in our study were similar to the subgroup of nondilated patients of Parker et al. 2I do not agree with this assumption because a major difference exists. In the report of Parker et al. , 2recovery was conditioned by the ability of the left ventricle to acutely dilate, and nondilated patients had a 100% mortality rate. Fortunately, it was not the case in our report, in which crude mortality was 40%.
