الفهرس 
Sepsis and Septic Shock
Echocardiography in ICUOnly 14 pages are availabe for public view
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Abstract
Summary
Sepsis, a life-threatening organ dysfunction caused by a dysregulated host response to infection associated with great mortality. Septic shock defined as a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality. The septic shock is the major cause of death in ICU, with rising prevalence and a total mortality rate of around 30%.
Sepsis can lead to reduced LV systolic function, hyperdynamic LV function, and diastolic dysfunction. So, recognition of these types of myocardial dysfunction with echocardiography could result in better results.
The pathophysiology of SIMD is multifactorial such as coronary blood flow misdistribution, injury of the myocardium, complementary (C5a) contractile myocyte failure, neutrophil activation by cytokines (TNF, IL-1β, IL-6), Ca manipulation dysregulation, and dysfunction of mitochondria that cause cellular hypoxia.
The role and occurrence of MD in septic shock have been more researched since the introduction of echocardiography to ICU medical practice. Not only systolic dysfunction but also diastolic dysfunction, or even a combination of both of them have been identified in sepsis and its occurrence can rise mortality rate up to 70%, but the true features of this specific septic organ failure remain unknown.
Echocardiography is a reliable and feasible imaging bedside tool as its non-invasiveness, costless and reproducible. Now a day, it is used as an essential tool in the management of critically ill septic patients for early diagnosis of possible cardiac dysfunction, caused by sepsis, and therefore allows monitoring and guiding hemodynamic management of septic patients.
Summary
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In this study, we aimed to evaluate the value of different parameters measured with trans-thoracic echocardiography and hemodynamics parameters for the diagnosis of sepsis-induced cardiac dysfunction in the surgical intensive care unit and therefore assessment of prognosis.
This prospective study was carried out in Tanta University Hospitals for two years, from October 2017 to October 2019, after having the approval from the ethical committee and informed written consent by the patient or his next of kin and all patients were volunteers.
This study included all the patients of both sexes with age between (18:50) years old admitted to SICU suffering from sepsis or septic shock after fulfillments of clinical criteria of sepsis including patients with suspected infection identified with quick sepsis-related organ failure assessment (qSOFA) which including: (alteration in mental status, systolic blood pressure < 100 mmHg and respiratory rate > 22/min). Organ dysfunction can be confirmed by acute change in sepsis-related organ failure assessment (SOFA) variables ≥ 2 points consequent to the infection which include: (PaO2/FiO2 ratio < 300, Glasgow Coma Scale score < 15, mean arterial pressure (MAP) < 70 mmHg, serum creatinine >1.2 mg/dl or urine output < 0.5 ml /kg/hr., serum bilirubin > 1.2 mg/dl and platelet count < 150 X 103 /µl). Or clinical criteria of septic shock including sepsis with persisting hypotension requiring vasopressors to maintain MAP > 65 mmHg and having a serum lactate level > 2 mmol/L despite adequate volume resuscitation.
Exclusion criteria were: (patients with renal failure (acute or chronic), other cause of shock, previous cardiac disease, rhythm other than sinus