الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Sepsis and septic shock are the most dangerous conditions presented to ICU physicians with high mortality and morbidity. The Third International Consensus Definitions (sepsis-3) defined Sepsis as life-threatening organ dysfunction caused by a loss of the regulation of the host response to the occurrence of infection. Septic shock is defined as a subdivision of sepsis in which there are profound circulatory and cellular metabolism deviations that leads to increased mortality. Early management is very important and crucial for achieving better outcomes.
Septic shock is characterized by the presence of hypotension, (MAP less than 65 mmHg) increased lactate level and persistent need for vasopressors. This signs of hypoperfusion affects the whole body systems leads to organ dysfunction. Impairment of the circulation leads to capillary leakage and this necessitate replacement of the fluid losses. Improvement of the microcirculation also depends on the usage of vasopressors. The sepsis induced myocardial dysfunction can also be corrected by using inotropes. These three main lines are the cornerstone for hemodynamic optimization for patients with septic shock.
The use of hemodynamic monitoring helped the guidance of proper usage for these lines of treatment. The use of fluid responsiveness tests, assessment of the vascular tone (through dynamic arterial elastance) and detecting myocardial dysfunction (by using VAC) greatly guided the practice for management of septic shock. The combination of these parameters and modalities for objective assessment was the core of this study.
This study aimed to evaluate a protocolized approach for hemodynamic optimization using VAC for critically ill patients with septic shock (HEMOVACS protocol).
This randomized controlled trial (RCT) was conducted on 100 adult patients who were admitted to the units of the department of Critical Care Medicine, Alexandria Main University Hospital with the diagnosis of septic shock requiring mechanical ventilation. The patients enrolled in this study were divided into two groups according to their subjectivity to the HEMOVACS protocol. group I patients (50 patients) underwent assessment by the HEMOVACS protocol and their management was guided by this protocol, while group II patients (50 patients) were managed using the conventional way of management without the use of the HEMOVACS protocol.