To the Editor:
The article by Boldt et al , which compares the cardiac response of hydroxyethyl starch with 5% albumin, requires further discussion. The authors state that the data suggest that in "septic" patients, cardiac index was significantly improved when treated with hydroxyethyl starch. This resulted despite the same wedge pressures in each group. However, in their discussion, the authors make no mention of the fact that their data also demonstrate that right ventricular end diastolic volume indices were also significantly higher in those patients who received the hydroxyethyl starch.
The editorial  that accompanied this article suggests that the observed differences were due to the nature of the particular solution used. However, I would suggest that we return to the basics. Clinically, pulmonary capillary wedge pressure has always been used in an attempt to ascertain diastolic volume. It is unclear why the authors did not account for diastolic volume changes. Their results clearly indicate that filling volumes were greater in those patients treated with hydroxyethyl starch. Therefore, one might expect the observed higher cardiac indices. Because these final resuscitation values were different, one cannot state that the observed findings were due to the solution used. Had enough albumin been given to develop the same end diastolic volume indices, the cardiac indices would likely have been the same in both groups.
T. James Gallagher, MD, FCCM
Department of Anesthesiology and Surgery; Division of Critical Care Medicine; University of Florida; Gainesville, FL 32610-0254
1. Boldt J, Hessen M, Muller M, et al. The effects of albumin versus hydroxyethyl starch solutions on cardiorespiratory and circulatory variables in the critically ill patient. Anesth Analg 1996;83:254-61.
2. Traylor RJ, Pearl RC. Crystalloid versus colloid versus colloid: all colloids are not created equal. Anesth Analg 1996;83:209-12.