A plea for balanced reporting

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I read with interest the study by Mayer and colleagues on
intraoperative hemodynamic optimization using Flotrac/
Vigileo [1]; however, the imbalance in their discussion
needs redressing. Citing a meta-analysis of esophageal
Doppler cardiac output (CO) validation studies that I co-
authored [2], they claimed this showed ‘limited accuracy’
and that ‘absolute CO measurements were found to be
imprecise’. Surprisingly, they made no mention of a
similar meta-analysis they published last year on the
FloTrac/Vigileo system [3] where the precision and bias
of the second generation device were no better!

Clearly, they wish to promote the device they use and
believe in, but it does no service to the medical and
scientifi c community to misrepresent one technology
over another. For example, they make no mention of the
limitations of the 12% pulse pressure variation value used
to predict fl uid responsiveness; with tidal volumes <8 ml/
kg, accuracy is only 51% [4] yet they did not report tidal
volumes delivered. Nor do they mention the inferior
results reported last year in an independent comparison
of the two devices undertaken for the French Agence
d’Evaluation des Produits de Sante [5].

Th ey did acknowledge an overall reduction of hospital
stay and complication rates in fi ve Doppler-directed
perioperative optimization studies (actually, nine such
studies are published to date). Is this not at odds with the
claimed ‘imprecision’? Th ey may be interested to learn of
a recent UK National Health Service Technology Adop-
tion Centre implementation project involving 1,247
surgical patients in 3 hospitals where these research
fi ndings could be reproduced in routine clinical practice,
with a 3-day reduction in hospital stay and fewer post-
operative complications [6]. I openly declare my aff ection
for the Doppler technology. It too has its imperf...
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