title: [Brazilian consensus of monitoring and hemodynamic support - part III: alternative methods for cardiac output monitoring and volemia estimation].
abstract: OBJECTIVE
  Cardiac 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.
  
  
  METHODS
  Modified 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.
  
  
  RESULTS
  Recommendations 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.
  
  
  CONCLUSIONS
  The 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.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Schettino
authors.forename: Rezende
authors.initials: R
authors.lastname: Ederlon
authors.forename: Ciro Leite
authors.initials: CL
authors.lastname: Mendes
authors.forename: Alvaro
authors.initials: A
authors.lastname: Réa-Neto
authors.forename: Cid Marcos
authors.initials: CM
authors.lastname: David
authors.forename: Suzana Margareth Ajeje
authors.initials: SM
authors.lastname: Lobo
authors.forename: Alberto
authors.initials: A
authors.lastname: Barros
authors.forename: Eliézer
authors.initials: E
authors.lastname: Silva
authors.forename: Gilberto
authors.initials: G
authors.lastname: Friedman
authors.forename: José Luiz Gomes do
authors.initials: JL
authors.lastname: Amaral
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.forename: Maristela
authors.initials: M
authors.lastname: Monachini
authors.forename: Mirella Cristine de
authors.initials: MC
authors.lastname: Oliveira
authors.forename: Murillo Santucci César
authors.initials: MS
authors.lastname: Assunção
authors.forename: Nelson
authors.initials: N
authors.lastname: Akamine
authors.forename: Patrícia Veiga C
authors.initials: PV
authors.lastname: Mello
authors.forename: Renata Andréa Pietro
authors.initials: RA
authors.lastname: Pereira
authors.forename: Rubens
authors.initials: R
authors.lastname: Costa Filho
authors.forename: Sebastião
authors.initials: S
authors.lastname: Araújo
authors.forename: Sérgio Félix
authors.initials: SF
authors.lastname: Pinto
authors.forename: Sérgio
authors.initials: S
authors.lastname: Ferreira
authors.forename: Simone Mattoso
authors.initials: SM
authors.lastname: Mitushima
authors.forename: Sydney
authors.initials: S
authors.lastname: Agareno
authors.forename: Yuzeth Nóbrega de Assis
authors.initials: YN
authors.lastname: Brilhante