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

Abstract Introduction: Static measures fail to accurately predict fluid responsiveness(FR) in critically ill patient and have been recently replaced by dynamic parameters. Non invasive transthoracic echocardiographic (TTE) measurement of subaortic velocity time integral variations(xVTI) and respiratory variations of inferior vena caval diameter(xIVCD) are two dynamic measures to predict FR. Aim of the work: is to test whether non invasive dynamic measurement of xVTI and xIVCD using TTE ,can predict fluid responsiveness after a mini fluid challenge. Methodology: 40 spontaneously breathing Pa-ents with acute circulatory failure secondary to sep-c shock admi.ed to ICU over 6 months period, TTE measures VTI by Doppler on a 5 chamber apical view, and IVCD in subcostal view in M-mode . Then 500 ml 6% Hydroxyethyl starch (HES) were infused via a speci{uFB01}c venous line, The {uFB01}rst 100 ml were regularly infused over 1 min. , the remaining 400 ml were infused at a constant rate over 14min.TTE reassessments were performed a8er the first minute and after completion of infusion. Results: Patients were Classified into two groups, responders or non responders according to FR, Fluid replacement remains the corner stone for resuscitation of patients with acute circulatory failure due to septic shock. Neverthless up to one half of patients of septic shock do not gain benefit from fluid therapy, moreover it can be counterproductive in many of them .

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