Author: Unknown (Letter to the Editor)
Anesthesia & Analgesia, 2025.
This letter critiques a clinical trial by Coeckelenbergh et al. comparing standard goal-directed fluid therapy (GDFT) with software-assisted fluid management (AFM) in high-risk surgical patients. While the trial reported that AFM improved cardiac output, perfusion, and microvascular flow, the authors raise several methodological concerns.
They argue that the microvascular flow index (MFI), chosen as the primary outcome, only reflects convective flow and may be less reliable than perfused vascular density. The quadrant-based method for MFI was criticized as subjective and inconsistent with vessel-level analysis. Additional issues include poor agreement between Automated Vascular Analysis (AVA) software versions, small baseline differences between groups, and challenges in interpreting variability in perfusion data.
Key Takeaways
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MFI may not be the best marker for microcirculatory outcomes compared to perfused vascular density.
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Quadrant-based video assessments introduce subjectivity and inconsistency.
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AVA software version differences can significantly alter results.
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Small baseline imbalances and methodological concerns weaken conclusions about AFM’s superiority.
Thank you to Anesthesia & Analgesia for publishing this important discussion on microcirculation research methodology.