Continuous Hemodynamic Monitoring During Laparoscopic Gastric Bypass in Superobese Patients by Pressure Recording Analytical Method

Abstract

As assessed by PRAM, this study showed no deterioration in hemodynamic indices or ventricular performance during laparoscopic gastric bypass.

Response to Dr. Bernstein’s Review: Pressure Pulse Contour-Derived Stroke Volume and Cardiac Output in the Morbidly Obese Patient

“…We do not concur with Dr. Bernstein's review [1]; PRAM may be useful to assess cardiovascular changes in obese patients during laparoscopy [2], but we believe also that every monitoring application that uses a calculated parameter should be seen in its trend rather than single value.…”

“…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][4][5].…”

“…Moreover, we do not believe that the end diastolic volume (EDV) value suggested by Dr. Bernstein [1], obtained by comparing different data measured in different circumstances (preoperative ambulatory ejection fraction with intraoperative SV measurement) [2], may be useful to predict the cardiovascular status of these patients.…”

Reply to Letter: Agreed: “PRAM May be Useful to Assess the Cardiovascular Changes in Obese Patients During Laparoscopy”

“…However, normalization by their respective BSAs (2.64 m 2 for Balderi et al [6] vs 2.41 m 2 for Dumont et al) produces a SI difference of 21%, which represents an unacceptable negative bias. It can therefore be stated that SI obtained by the PRAM method substantially underestimated the SI estimate found by TDCO.…”

“…Thus, the authors ought to have stated that, for a beat-to-beat method measuring SV, comparing measurements of absolute SV and CO between different methods and patient populations is misleading. The authors must have known this to be correct because Balderi et al [6], the subject of the commentary and reply, reported their results as SI and CI ( As evidence that their values for SI and CI index are consistent with the literature, they cite studies using alternative methodology, including transesophageal echocardiography (TEE) [7] transesophageal echo-Doppler velocimetry [8] and impedance cardiography (ICG) [9,10]. Indeed, using TEE and transesophageal echo-Doppler techniques, values similar to those obtained by PRAM are reported [7,8].…”