الفهرس 
Initial ResuscitationOnly 14 pages are availabe for public view
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Abstract
Sepsis, a syndrome of physiological, pathological, and biochemical abnormalities induced by infection, is a major public health concern, accounting for more than $20 billion (5.2%) of total hospitals costs in 2011.
Risk factors for severe sepsis are related both to a patient‟s predisposition for infection and to the likelihood of acute organ dysfunction if infection develops. There are many well-known risk factors for the infections that most commonly precipitate severe sepsis and septic shock, including chronic diseases (e.g., the acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, and many cancers) and the use immunosuppressive agents among patients with such infections.
Adequate fluid resuscitation is one of the keystones in the management of severe sepsis and septic shock. Determining the appropriate amount of fluid resuscitation to administer to a critically ill patient is a complex decision. Assessment of fluid responsiveness remains a daily therapeutic challenge in critically ill patients with acute circulatory failure (ACF).Traditional methods of determining the adequacy of volume resuscitation have relied on one or another measure of preload, that is, central venous pressure (CVP), pulmonary artery wedge pressure (PAWP). Also known as static parameters. However, none of these is accurate in predicting preload responsiveness.
Transthoracic echocardiography (TTE) allows a noninvasive bedside assessment of cardiac response to volume expansion by measuring aortic velocity time integral variation (%VTIa) during a fluid challenge. As a surrogate of left ventricle stroke volume (SV) variation. Transthoracic echocardiography is often used as a comparator for the validation of new cardiac output (CO) measurement techniques. The Doppler study of femoral artery circulation is simple and overpasses this common limit among intensive patient. Moreover, it showed to be an easy-learning tool.
Therefore the present observational study was conducted to compare between LVOT VTI and Femoral artery Doppler measurements as a useful predictor to fluid responsiveness after infusion of 30 ml/kg of NaCl 0.9% within 60 minutes in patients septic shock.
The study was conducted on 30 adult male and female patients admitted to Critical Care Department in Ain shams University Hospitals with the diagnosis septic shock. All patients in this study were have the Criteria of Septic shock.
Echocardiographic examination was done for all included patients and LVOT VTI was measured before fluid resuscitation, after infusion of 30ml/kg over 60 minutes, and (%LVOT VTI) variations was calculated which separated the studied population into two groups.
Responders (R): 22 septic shock patients with LVOT ΔVTI ≥ 15%.
Non-responders (NR): 8 septic shock patients with LVOT ΔVTI<˂ 15%.
Simultaneously Velocity time integral (VTIf) and maximal systolic velocity (Vfmax) was recorded before and after fluid challenge of 30ml/kg of NaCl 0.9% within 60 minutes, and Velocity time integral variation (%VTIf) and maximal systolic velocity variation (%Vfmax) was calculated which separated the studied population into two groups.
Responders (R): 23 septic shock patients with %VTIf ≥ 15%.
Non-responders (NR): 7 septic shock patients with %VTIf < 15%.These results showed that femoral Doppler parameters were a reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock as well as transthoracic echocardiography in dynamic monitoring the change in stroke volume after a maneuver that increases or decreases venous return (preload).