الفهرس 
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Abstract
It is now widely recognized that both inadequate and excessive fluid replacement are deleterious to health, and both can affect recovery during Critical illness [255]. Clinical studies have consistently demonstrated that only about 50% of hemodynamically unstable patients are volume responsive(10,11). It is therefore essential to have reliable bedside tools to predict the efficacy of volume expansion, and thus distinguishing patients who might benefit from volume ex-pansion from those in whom the treatment is likely to be inefficacious (10, 11).
Many studies have focused on the prediction of fluid responsiveness and many different dynamic markers of fluid responsiveness have been studied in recent years [11-14]. There are two techniques that are widely available, practical, easy to perform, and physiologically based, which can be used to determine fluid responsiveness with a high degree of accuracy, namely, the Passive Leg Raising (PLR) maneuver and the fluid challenge[7[
These techniques are best coupled with minimally invasive or noninvasive cardiac output monitors, which can track changes in stroke volume (SV) dynamically and in real time [12)
We had investigated the accuracy of carotid artery flow measurement in assessment of fluid responsiveness in critically ill septic patients. We also had evaluated the accuracy of PLR maneuver as a simple easy method in hemodynamic evaluation of critically ill septic patients.
The study was conducted on fourty critically ill septic patients admitted to Critical Care Department of benisuef University Hospitals, indicated to fluid challenge for hemodynamic optimization. The patients were enrolled in this study after gaining informed consent from patients or their relatives.
All patients were subjected to detailed history taking , Thorough clinical examination , SBP , DBP and MAP measurement, Full laboratory investigations besides, Radiological examination as appropriate , 12-lead ECG recording. A three sets of measurements of hemodynamic variables (HR, RR, non-invasive MAP, CVP), Echocardiographic data variables (LVOT VTI, LVOT SV, COP and left ventricular ejection ejection fraction) And common carotid artery data variables (corrected flow time) were obtained in the semi-recumbent position, post PLR.
Our study results showed that 45% (n=18) of study population were fluid responders. The PLR test could assess fluid responsiveness with specificity 100% and sensitivity 95% with cut of 10.6% change in CO to predict fluid responsiveness.
We found a statistically significant moderate positive correlation between CCA corrected flow time (cFT) both after PLR and the percent of change in CO measured by echocardiography. An agreement analyses were formed, we concluded that an overall good agreement between blood flow measurement and Doppler echocardiography carotid measurement with P value < 0.001, so we can use this parameters to predict fluid responsiveness post PLR.