Maintenance of adequate cardiac preload is of paramount importance in the treatment of patients undergoing major surgical surgery and in the critically ill setting. The end point is to maintain the organ perfusion through volume replacement and therapy to optimize cardiac output, oxygen deliver. Various methods have been introduced into clinical practice to estimate cardiac preload. In the last 10 years the transpulmonary indicator dilution technique showed to be accurate as hemodynamic-volumetric monitoring. We briefly review the intra thoracic blood volume index as a preload index and the fluid responsiveness indexes, stroke volume variation and pulse pressure variation, available as novel parameters at the bed-side. The optimization of fluid balance and vasoactive drugs administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system where intravascular volume management is a primary objective.