Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: Assessment of patients with fluid resistant septic shock by echocardiography helps in accurate measurement of stroke volume index, cardiac index and systemic vascular resistance index which is crucial in hemodynamic monitoring. Aim: Goal directed management with proper choice of the vasoactive agent to fasten resuscitation and improve survival. Methodology: Fourty five children aging from two month to ten years were included, all the children fulfilled the criteria of fluid resistant septic shock, cases were recruited from the pediatric intensive care unit in Cairo university specialized pediatric hospital. Clinical examination was done in the form of assessment of vital signs, capillary refill time and central venous pressure, echocardiographic monitoring was done and data were obtained as time velocity integral, stroke volume index, cardiac index and systemic vascular resistance index, clinical and echocardiographic assessment were done at the time of PICU admission before inotropic support, 6 hours, 24 hours and then by the end of resuscitation of septic shock. Results: We found significant statistical increase in values of cardiac index (P value <0.001), stroke volume index (P value <0.001), TVI (P value<0.001) and MPI (P value<0.001) was found by the end of resuscitation. Significant negative correlation was found between cardiac index and systemic vascular resistance index at all time intervals (at admission: r= -0.652, P<0.001, by resuscitation: r= -0.717, P<0.001). Thirty three cases survived (73.3%) and twelve died (26.7%), The median resuscitation time of survivors was 33.6 hours, the cardiac output was found significantly higher in non-survivors compared to survivors (P: 0.021), SVRI was found significantly lower in non survivors compared to survivors P: 0.01

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