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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank Llorens et al. for the comments on our article<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> on the developments in the 2016 heart failure (HF) guidelines of the European Society of Cardiology,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> notably the marked increase in the number of recommendations regarding the treatment of acute HF.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We agree that the subjectivity in measuring congestion and perfusion impedes the practical application of the new pathophysiological classification of acute HF. At least in the short term, this means that blood pressure will continue to be the variable that guides the initial treatment. Nevertheless, the ultrasound measurement of the diameter and inspiratory collapse of the inferior vena cava helps indirectly estimate the degree of systemic congestion at the patient's bedside.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> In future, it would be desirable for all physicians who treat patients with acute HF to be able to perform this technique.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We also agree that there is still insufficient evidence to recommend the administration of loop diuretics in continuous infusion versus the injection of boli. From a pathophysiological point of view, continuous administration should provide greater diuresis, by decreasing the compensatory renal sodium retention (“postdiuretic effect”).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,5</span></a> Despite this, neither the Diuretic Optimization Strategies Evaluation study<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> or a systematic Cochrane review<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> have managed to demonstrate a benefit with the continuous administration of loop diuretics.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, we agree on the importance of considering prehospital care and the patient's prognosis after the initial care in the emergency department, in the comprehensive care for acute HF. Due to their prognostic importance,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> these aspects warrant addressing in future editions of the HF clinical guidelines.</p></span>"
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