title: [Brazilian consensus of monitoring and hemodynamic support - Part IV: tissue perfusion evaluation].
abstract: OBJECTIVE
  The main cardiovascular function is to maintain the adequate perfusion e oxygen delivery to the cells. Physiologically, this is controlled by the cellular metabolic rate. The critically ill patients are in high danger of tissue hipoperfusion and this is directly related to cellular injury and organ dysfunction. Therefore, the tissue perfusion monitoring makes part and is indissociated of hemodynamic evaluation of the critically ill patient and is indicated to all this patients. The objective was to define recommendations about clinical utility of different tolls to bedside perfusion monitoring.
  
  
  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 five 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 were done about the utility of clinical monitoring of tissue perfusion, temperature gradient and transcutaneous oxygen monitoring, serum lactate, base excess, SvO² and ScvO², gastric and sublingual capnometry, CO² venous-arterial gradient and Orthogonal Polarization Spectral (OPS).
  
  
  CONCLUSIONS
  The homodynamic compensation of a critically ill patient isnt complete unless the tissue perfusion is corrected. Many different methods of monitoring is available and are useful in clinical practice, however, none has accuracy and effectiveness characteristics to be used independently of clinical context.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Réa-Neto
authors.forename: Ederlon
authors.initials: E
authors.lastname: Rezende
authors.forename: Ciro Leite
authors.initials: CL
authors.lastname: Mendes
authors.forename: Cid Marcos
authors.initials: CM
authors.lastname: David
authors.forename: Fernando Suparregui
authors.initials: FS
authors.lastname: Dias
authors.forename: Guilherme
authors.initials: G
authors.lastname: Schettino
authors.forename: Suzana Margareth Ajeje
authors.initials: SM
authors.lastname: Lobo