• Guilherme Schettino, Rezende Ederlon, Ciro Leite Mendes, Alvaro Réa-Neto, Cid Marcos David, Suzana Margareth Ajeje Lobo, Alberto Barros, Eliézer Silva, Gilberto Friedman, José Luiz Gomes do Amaral, Marcelo Park, Maristela Monachini, Mirella Cristine de Oliveira, Murillo Santucci César Assunção, Nelson Akamine, Patrícia Veiga C Mello, Renata Andréa Pietro Pereira, Costa Filho Rubens R, Sebastião Araújo, Pinto Sérgio Félix SF, Sérgio Ferreira, Simone Mattoso Mitushima, Sydney Agareno, and Yuzeth Nóbrega de Assis Brilhante.
• Rev Bras Ter Intensiva. 2006 Mar 1; 18 (1): 78-85.

Background And ObjectivesCardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the critical care setting, particularly for patients with signs of tissue hypoperfusion. Although PAC remains the " gold standard" to measure cardiac output and preload, new and alternative technologies were developed to evaluate these hemodynamic variables.MethodsModified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty three physician and two nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004.ResultsRecommendations regarding the use of arterial pulse pressure variation during mechanical ventilation, continuous arterial pulse contour and lithium dilution cardiac output measurements, esophageal Doppler waveform, thoracic electrical bioimpedance, echocardiography and partial CO2 rebreathing for monitoring cardiac output and preload were created.ConclusionsThe new and less invasive techniques for the measurement of cardiac output, preload or fluid responsiveness are accurate and may be an alternative to PAC in critically ill patients.

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