Rebuttal to: “As simple as possible, but not simpler: estimating the effective arterial elastance at bedside”

  • Manuel Ignacio Monge GarciaEmail author
  • Zhongping Jian
  • Jos J. Settels
  • Feras Hatib
  • Maurizio Cecconi
  • Michael R. Pinsky

We would like to thank to Chemla et al. for their valuable comments about our recent experimental study. These authors suggested that effective arterial elastance (Ea) using systolic arterial pressure (SAP) incorporates the oscillatory component of arterial load, whereas Ea using mean arterial pressure (MAP) does not. They implied the role of arterial stiffness in the discrepancy between MAP and Pes. The same group has recently published a clinical study using 90% of SAP for estimating Ea, and they suggested to use femoral SAP as surrogate of left ventricular end-systolic pressure (Pes) [1].

Effective arterial elastance attempts to simplify the complexity of arterial input impedance into one single variable. This simplification, however, is not without its drawbacks. As Ea is derived from a simple lumped model of arterial system as the three-element Windkessel [2], it does not include the impact of arterial wave reflections. This is a well-known and inherent limitation of Ea [2, 3]....



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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Manuel Ignacio Monge Garcia
    • 1
    Email author
  • Zhongping Jian
    • 2
  • Jos J. Settels
    • 2
  • Feras Hatib
    • 2
  • Maurizio Cecconi
    • 3
  • Michael R. Pinsky
    • 3
    • 4
  1. 1.Unidad de Cuidados IntensivosHospital Universitario SAS de JerezJerez de la FronteraSpain
  2. 2.Edwards LifesciencesIrvineUSA
  3. 3.Department Anaesthesia and Intensive Care UnitsHumanitas Research Hospital, Humanitas UniversityMilanItaly
  4. 4.Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA

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