Response

SONIC CENTRAL study 1 and the letter by Greenstein and Geuvarra. 2We fully agree that central venous pressure (CVP), like any hemodynamic variable, should not be interpreted in isolation.Rather than trying to "see the forest through 1 tree," our goal was to take a closer look at 1 of the more accessible trees and explore how it contributes to the broader hemodynamic picture when assessed accurately.We consider the internal jugulair vein collapse point a pragmatic and reproducible surrogate for CVP.Our aim was not to reintroduce CVP as a predictor of fluid responsiveness-a topic that has been well covered in previous literature 3 -but to investigate whether ultrasound-based CVP estimation can still support bedside diagnosis and clinical reasoning.We appreciate the authors' use of the Diamond-Forresterinspiredmatrix to show how CVP can be part of clinical decision-making. 4We believe the SONIC CENTRAL findings may complement such frameworks by helping clinicians identify patients in Quadrants 3 and 4 in a noninvasive way.We agree that SONIC CENTRAL is of value to ICU sonographers-and we add that it may be equally relevant for non-ICU sonographers working in the emergency department or on the ward, where invasive monitoring is less available and US-based hemodynamic evaluation can meaningfully support bedside clinical decisions.Finally, we support the call for dynamic and physiologybased approaches to volume management.As ultrasound evolves from static assessment toward integrated hemodynamic profiling, studies such as SONIC CENTRAL aim to offer practical pieces of the larger diagnostic puzzle.