الفهرس 
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Abstract
Many forms of critical illness may present with shock. Shock is not necessarily defined by hypotension. That is, a patient can be normotensive and have shock in the same time. Accordingly, the definition of shock is mainly based on in adequate oxygen delivery to tissues. When tissue oxygen requirements are not met by the circulatory system, If it is due to myocardial function affection, hypovolemia, and/or hypotension, a patient is said to be shocked
Pediatric septic shock is a sepsis combined with cardiovascular organ dysfunction. Consequently, myocardial dysfunction and circulatory instability are the leading causes of death.
Noninvasive cardiac output (CO) estimation through echocardiography has shown to be an accurate, confident, and easy tool to use in critically ill patients
Changes in CO and left ventricle (LV) stroke volume (SV) could be quantified through pulsed wave doppler determinations using the velocity time integral (VTI) and the LV outflow tract (LVOT) diameter. LVOT-VTI provides adequate information to follow stroke volume changes
The present study aims to assess the role of (LVOT–VTI) in the reduction of shock reversal time in pediatric septic shock by optimizing fluid and vasoactive/inotropic therapy.
Our study was conducted on 60 patients admitted with new onset septic shock to pediatric intensive care unit in Menoufia University Hospital, from August 2019 to May 2020.
Their age was from 1 month to 13 years. 19 were males and 41were females.
All patients gone throw full history taking, clinical examination, laboratory assessment (complete blood count, liver function tests, kidney function tests, C-reactive protein, and blood culture) and echocardiography (including EF% and serial measurement of left ventricular outflow velocity time integral in study group A (in which septic shock was managed in accordance with the Surviving Sepsis Campaign SSC guidelines, but was modified based on transthoracic echocardiography findings) to guide fluid and vasoactive- inotrope therapy).
Our results as regards mechanical ventilation found that mechanical ventilation was significantly lower in the study group A.
In the study group A, inotropes were initiated earlier than the control group B (in which septic shock was managed in accordance with the Surviving Sepsis Campaign SSC guidelines).
Vasoactive infusion score (VIS) score was significantly lower in group A than in group B.
Concerning hospital stay and mortality rates they were significantly lower in group A.
Using LVOT-VTI in guidance of fluid therapy was found protective against volume overload due to excessive unnecessary fluid therapy in study group A.
Our study concluded that Shock reversal time and vasoactive therapy withdrawal time were significantly lower in group A.