الفهرس 
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Abstract
Effective monitoring of tissue perfusion and cardiac output in sepsis is the key to early goal directed therapy and to reach effective resuscitation end points.
Cardiac output monitoring techniques include conventional invasive techniques (e.g pulmonary artery catheterization and direct Fick method ) and recent minimally invasive techniques (e.g oesophageal Doppler,transesophageal echocardiography, partial carbon dioxide rebreathing, transpulmonary thermodilution, lithium indicator dilution, and pulse contour and pulse power analysis ) which were developed to overcome the limitations of invasive methods for CO monitoring.
Recently sepsis is being described as a disease of microcirculation.
However, current monitoring techniques are mainly based on systemic variables which have been shown to provide incomplete information aabout the severity of disease and have not provided effective resuscitation end-points.
So, the new monitoring approaches should concern assessment of microcirculatory and cellular function at the bed-side.A lot of monitoring techniques have been described to monitor the microcirculation.These include tonometry, laser Doppler flowmetry, reflectance spectorphotometry, orthogonal polarization spectral imaging, plasma D-lactate measurement.
Although, there are alot of recent techniques to monitor tissue perfusion at the level of macrocirculation and microcirculation, they still fail to identify accurate resuscitation end points in managing patients with sepsis and septic shock.
At the end of our study, we recognize that future achievements in improving sepsis outcome should focus on the following priorities:
Tring to estimate accurate resuscitation end points for cardiac output based resuscitation in sepsis.
Validate simple, accurate monitoring techniques to assess microcirculatory dysfunction.
New therapeutic strategies for sepsis and septic shock.