Thesis (Ph.D)-Cairo University, 2020.

Bibliography: pages 116-138.

This is an observational prospective study that was conducted on thirty
patients admitted to the Sahla hospital ICU from June 2019 till January 2020
and diagnosed with sepsis or septic shock on admission and through their ICU
stay.
On admission all patients underwent full history taking, complete clinical
examination, full laboratory investigation and transthoracic echocardiography,
Chest x-ray, Electrocardiogram (ECG). All patients will be managed according
to Surviving Sepsis Campaign: International Guidelines for Management
of Sepsis and Septic Shock: 2016, 2018.(15, 27)
Both excursion and thickness of diaphragm (TDI %) will be measured by
ultrasonography (US) on admission and every 48 hours during the patients’
ICU stay.
The Diaphragmatic Excursion (DE): The diaphragm inspiratory
amplitudes (excursions) will be measured from the M-mode sonography at the
bedside The probe will be placed between the mid-clavicular and anterior
axillary lines on the right side and directed medially, cranially, and dorsally.
The diaphragmatic thickness fraction (TDI%): Will be performed with B-
mode US device in the supine position with an average inclination of 45 degree;
The position of the probe will be set to obtain the best view of the zone of
apposition of the diaphragm, located between the mid axillary and the posterior
axillary line in. Diaphragmatic thickness will be measured on the right side at
end-inspiration and end expiration. The change in diaphragmatic thickness
(ΔTdi) during spontaneous breathing from functional residual capacity (FRC)
to Vt will be calculated as follows:
Δ Tdi % = End-Inspiration thickness− End-Expiration thickness × 100
End-Expiration thickness
There were 10 males (33.3%) and 20 females (66.7%) With mean age
71.87 ±17.42 years.
The mean of CRP in our study on admission was 170.43 ± 78.10
while its average through the whole ICU stay was 170.36 ± 78.75mg/L.
the APACHE II in our study had mean of 33.40 ± 9.66.
In this study 22 patients (73.3%) were mechanically ventilated with
5.33 ± 4.38 days and 8 of those patients (38.4%) were successfully weaned
from Mechanical Ventilation (MV).
In our study there was significant direct relation between the APACHE
and the need of MV with p value 0.012*as mechanically ventilated patients
had higher APACHE II with mean 36.0 ± 8.94. And there was significant
reverse relation between the APACHE II and successful weaning from
with p value 0.002* as the successfully weaned patients had lower APACHE
with mean 28.88 ± 5.41.
Regarding the DE measured by M mode ultrasonography in our study
admission it had mean of 1.19 ± 0.68 cm and The DE average through the
ICU stay had mean of 1.21 ± 0.58 cm. While the TDI% measured by B
ultrasonography in our study on admission its mean was 34.47 ± 22.45%
its average mean was 33.27 ± 15.37%.
Regarding the DE there was statistically significant reverse relation
between mortality and the DE on admission to ICU and average levels of
with p value of 0.005*, of 0.003*respectively. The same was found between
mortality and TDI% on admission to ICU with p value of 0.033* and
average levels of TDI% with p value of 0.003*.

في حين أن الإنتان والصدمة الإنتانية هما من مشاكل الرعاية الصحية الرئيسية ، التي تؤثر على ملايين الأشخاص حول العالم كل عام ، ويوجد هناك الكثير من القياسات و العلامات والدراسات لتقييم شدة المرض والتكهن بمصير المرضى اثناء تواجدهم بوحدة العناية المركزة.
نمت مؤخرًا امكانيه قياس وظيفة الحجاب الحاجز لتصبح موضوعًا ذا أهمية كبيرة بسبب تأثيرها السريري السلبي على احتياج وضع المريض على جهاز تنفس صناعي وطول فتره التنفس الصناعي ونتائج الفطام من عليه ، والنتيجة طويلة المدى في مريض وحدة العناية المركزة. كما أتضح وجود صله كبيره بين اضطراب وظائف الحجاب الحاجز وتأثيرها على طول فتره اقامه المريض بالعناية المركزة.
عد استخدام الموجات فوق الصوتية في وحدة العناية المركزة مجالًا يثير اهتمامًا متزايدًا نظرًا لقابلية حمله وسرعته وسلامته والنتائج المشجعة التي تم الحصول عليها وليس لديه خطر من الإشعاعات المؤذية, ويمكنه توفير الكثير من البيانات المورفولوجية والوظيفية حول الحجاب الحاجز ويسمح بتصوير الاعضاء فوق وأدنى الحجاب الحاجز.. وقد ثبت أن الموجات فوق الصوتية مماثلة في الدقة لمعظم طرائق التصوير الأخرى لتقييم الحجاب الحاجز.

Issued also as CD

Text in English and abstract in Arabic & English.