Echocardiography Guided Fluid Resuscitation in Critically Ill Patients.
Echocardiography Guided Fluid Resuscitation in Critically Ill Patients.
To compare between the impact of echocardiography guided fluid resuscitation and clinically
 guided fluid resuscitation on critically ill patients in hospital outcome.
Resuscitation often requires the infusion of intravenous fluid in an effort to reverse organ
 dysfunction. The harms of inappropriate use of fluid are becoming increasingly apparent The
 question of whether the patient improves with fluid, additional vasopressors or inotropes can
 be difficult to answer. The gold standard for assessing fluid responsiveness to guide fluid
 administration in critically ill patients is to perform a fluid challenge. The rationale for
 volume expansion is to increase the cardiac output (CO) and oxygen delivery to ultimately
 improve tissue oxygenation. This involves the infusion of a specific amount of intravenous
 fluid to assess ventricular preload reserve and subsequent systemic haemodynamic effects. In
 a patient with acute hemodynamic instability, a fluid challenge will cause an increase in
 stroke volume, according to the Frank-Starling curve. This increase in stroke volume has a
 salutary effect because it improves tissue perfusion. In contrast, higher hydrostatic
 pressures in the vascular system predispose the patient to edema, organic dysfunction, and
 increased risk of in-hospital mortality.

 Fluid responsiveness is conventionally defined as an increase of at least 10% to 15% in SV in
 response to a fluid challenge, which is a reflection of the limits of precision of the
 technology used.

 Assessment of the response in flow to a fluid challenge can be guided with echocardiography.
 It is achieved by measuring left ventricular outflow tract velocity time integral (LVOT VTI)
 immediately before and after fluid challenge.
Inclusion Criteria:

 1- All Critical ill-patients with Acute Physiologic Assessment and Chronic Health
 Evaluation II score (APACHE II score)≥ 25

 Exclusion Criteria:

 1. Bad echocardiographic window

 2. APACHE II score < 25.