Réa-Neto Alvaro, Rezende Ederlon, Mendes Ciro Leite, David Cid Marcos, Dias Fernando Suparregui, Schettino Guilherme, Lobo Suzana Margareth Ajeje
Rev Bras Ter Intensiva. 2006 Jun;18(2):154-60.
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.
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.
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).
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.
心血管的主要功能是维持对细胞的充分灌注和氧输送。在生理状态下，这受细胞代谢率的控制。危重症患者存在组织灌注不足的高风险，这与细胞损伤和器官功能障碍直接相关。因此，组织灌注监测是危重症患者血流动力学评估的一部分且与之不可分割，适用于所有此类患者。目的是确定关于不同床边灌注监测工具临床应用的建议。
采用改良德尔菲法在参与者之间达成并量化共识。AMIB指定了一名协调员，该协调员邀请了另外六位监测和血流动力学支持领域的专家组成共识咨询委员会。从该国不同地区选出的25名医生和2名护士组成了专家小组，他们查阅了1996年至2004年期间MedLine上列出的相关文献。
针对组织灌注的临床监测、温度梯度和经皮氧监测、血清乳酸、碱剩余、SvO²和ScvO²、胃和舌下二氧化碳监测、二氧化碳动静脉梯度以及正交极化光谱（OPS）的应用给出了建议。
除非组织灌注得到纠正，否则危重症患者的血流动力学代偿是不完全的。有许多不同的监测方法可供临床实践使用，然而，没有一种方法具有能独立于临床背景使用的准确性和有效性特征。
