الفهرس 
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Abstract
Assessment of intravascular volume status is difficult in critically ill patients. Evidence suggests that only 50% of hemodynamically unstable patients respond to a fluid challenge.1‘2 Moreover, if cardiopulmonary function cannot compensate for the increase in preload, fluid loading may compromise microvascular perfusion and oxygen delivery and cause or aggravate peripheral and pulmonary edema 3‘4.
Therefore, inappropriate fluid expansion can increase morbidity and mortality 5‘6‘7, thus making it important to accurately assess fluid responsiveness in critically ill patients 8‘9.The volume responsiveness can be defined as a 15% increase in stroke volume (SV) or cardiac output (CO) after a 500-ml infusion 10‘11‘12.
This study tested whether echocardiographic parameters can predict fluid responsiveness in critically ill patients following a low volume 100-ml crystalloid solution infusion over 1 minute.
This prospective single-group observational study was conducted in a general adult critical care unit (CCU) at Menoufia University Hospitals,fromJanuary 2016 to March 2017.
On admission to icu : All included patients were subjected for thorough clinical evaluation including history, physical examination, routine laboratory investigations then
•Hemodynamic assessment : baseline Heart rate , blood pressure , temperature, respiratory rate, central venous pressure , oxygen saturation , and urine output measurement were recorded .
•Scoring System: (APACHE II) and SOFA score was calculated.
Measurements
•Before volume expansion, Baseline HR, systolic, diastolic and mean arterial pressures, central venous pressure, and Temperature were monitored and recorded .and also mechanical ventilation parameter(tidal volume, respiratory rate and PEEP) for each patient.
•Echocardiographic parameters were measured by an experienced ultrasound physician using a bedside Philips with a 3- to 5-MHz phased-array probe. M-mode (time-motion) echocardiography was employed at the level of the aortic annulus in a two-dimensional view from the parasternal long-axis window. We measured the aortic diameter (D), left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and HR. we determined the left ventricular end-diastolic volume (LEDV) and left ventricular end-systolic volume (LESV). Aortic blood flow and velocity time integral (VTI) was obtained from an apical five-chamber view. In addition, HR, blood pressure, CVP, The following equations was used to calculate additional parameters:
SV = [LEDV – LESV]; left ventricular ejection fraction (LVEF, %) = [(SV ÷ LEDV) × 100];andCO = [SV × HR].
A 100 ml bolus of crystalloid solution was given to the patient over 1 minute through a central venous catheter or jugular cannula .VTI was recorded immediately after bolus administration. The remaining 400 ml of crystalloid solution was infused at a constant rate over 10 minutes, and the VTI was measured again. The mean echocardiographic measurements over three consecutive respiratory cycles were recorded, and parameters were analyzed by using frozen images from M-mode recordings. Changes in parameters (HR, CVP,
BP, LVESD , LVEDD, Aortic diameter VTI, SV, and CO) were measured after the 100-ml infusion over 1 minute and after the 400 ml over 10 minutes with total 500 ml ; Those measurements was referred to as 100 and 500 respectively. Patients with an increase in CO after a 100 ml or total 500-ml infusion over 10 minutes (ΔCO500) of 15% or more was classified as responders (Rs) and those without increase in CO was classified as non-responders (NRs).
Out of 54 patients included in our study there were 32 responders and 22 non responders. There was no significant difference between responders and non-responders regarding age, gender, height and body weight.
No significant difference had been observed between both groups concerning heart rate or APACHEII score.
As regard to mean arterial blood pressure (MAP) There was no significant difference between both groups regarding baseline MAP and MAP after 100ml fluid infusion. But there was a significant difference between responders and non-responders after 500ml fluid infusion.
There was no significant difference between responders and non-responders concerning baseline mean CVP, mean CVP following 100ml fluid infusion and mean CVP after infusion of 500 ml of fluid .
A significant difference between responders and non- responders was clear concerning mean VTI, SV and CO at the baseline, after 100 ml fluid infusion, Also the difference was significant between both groups after 500 ml fluid infusion