Reply:
We thank Dr. Bloomstone and colleagues for their commentary on our study. We agree that the study is limited by small sample size, and that conclusions from small studies should not be overstated. We were careful to employ non-parametric techniques in our analyses but affirm that early observations from small studies should not be seen as clinically definitive, regardless of the statistical technique employed. We believe that our results justify further study and that external validation is necessary before widespread clinical acceptance is justified. Such validation is underway in our center and has been recently published by Muller and colleagues.1
Footnotes
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References
- 1.Muller L, Bobbia X, Toumi M, et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care. 2012;16:R188. doi: 10.1186/cc11672. [DOI] [PMC free article] [PubMed] [Google Scholar]