Schettino Guilherme, Ederlon Rezende, Mendes Ciro Leite, Réa-Neto Alvaro, David Cid Marcos, Lobo Suzana Margareth Ajeje, Barros Alberto, Silva Eliézer, Friedman Gilberto, Amaral José Luiz Gomes do, Park Marcelo, Monachini Maristela, Oliveira Mirella Cristine de, Assunção Murillo Santucci César, Akamine Nelson, Mello Patrícia Veiga C, Pereira Renata Andréa Pietro, Costa Filho Rubens, Araújo Sebastião, Pinto Sérgio Félix, Ferreira Sérgio, Mitushima Simone Mattoso, Agareno Sydney, Brilhante Yuzeth Nóbrega de Assis
Rev Bras Ter Intensiva. 2006 Mar;18(1):78-85.
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.
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.
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.
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.
心输出量和前负荷作为绝对数据，无法为危重症患者的血流动力学提供有用信息。然而，监测这些变量对容量负荷试验或血管活性药物的反应，在重症监护环境中是一项非常有用的工具，尤其对于有组织灌注不足体征的患者。尽管肺动脉导管（PAC）仍然是测量心输出量和前负荷的“金标准”，但已开发出新的替代技术来评估这些血流动力学变量。
采用改良的德尔菲法在参与者之间达成并量化共识。阿根廷重症监护医学学会（AMIB）指定了一名协调员，邀请了该领域另外六名监测和血流动力学支持方面的专家组成共识咨询委员会。从该国不同地区选出的23名医生和2名护士组成了专家小组，该小组查阅了1996年至2004年期间MEDLINE上列出的相关文献。
针对机械通气期间动脉脉搏压变异、连续动脉脉搏轮廓和锂稀释心输出量测量、食管多普勒波形、胸电阻抗、超声心动图以及部分二氧化碳重吸入用于监测心输出量和前负荷的使用提出了建议。
用于测量心输出量、前负荷或液体反应性的新的、侵入性较小的技术是准确的，在危重症患者中可能是肺动脉导管的替代方法。
