الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Background: sepsis occurs when the body’s immune system overreacts to an infection. In its final stages, this can cause organ failure and death. Contractile dysfunction is the main characteristic of cardiac dysfunction in sepsis, and it manifests as biventricular dilatation, a reversible decrease in ejection fraction, a diminished blood pressure response to intravenous fluid resuscitation, and an inability to improve cardiac output
AIM OF THE WORK: The aim of the work is to predict mortality in mechanically ventilated patients with septic shock using echocardiographic tissue Doppler imaging to evaluate right ventricle diastolic dysfunction.
Patients and methods: A prospective study was done on 140 patients at critical care units of Alexandria Main University from December 2021 to June 2022.All patients above 18 y with septic shock mechanically ventilated are included in this study. Patients with cardiac diseases known by history of EF less than 40% were excluded. Also, patients with moderate or severe mitral or aortic valvular diseases were excluded from the study. Standard 12 leads ECG assessment was done to all patients to detect rhythm, chamber enlargement and to exclude ischemic changes. At time of ICU admission all the patients underwent History taking and physical examination, Laboratory assessment and echocardiographic assessment. Physical examination included vital signs, mean arterial blood pressure, vasopressor dose, APACHE-II scores and SOFA score. Laboratory assessment included CBC, liver and kidney function test, arterial blood gases and serum lactate Echocardiographic assessment including three main parameters, traditional Echocardiography including right and left ventricular systolic and diastolic volumes and diameters, conventional doppler for trans-tricuspid flow Doppler velocities (E, A, and E/A ratio) and tissue doppler imaging for tricuspid valve annulus tissue Doppler velocities (E′, A′), deceleration time, and isovolumic relaxation time. 140 patients are classified according to mortality into two groups survivors (n=78) and non-survivors (n=62).
Results: All data obtained at time of ICU admission underwent full statistical analysis to compare between the two studied groups (survivors & non-survivors). There was no statistically significant difference between the two studied groups in demographic, physical examination and laboratory parameters at time of ICU admission. But there was statistically significant difference between the two studied groups in conventional doppler measured waves & tissue doppler imaging at tricuspid valve. At time of ICU admission, all conventional doppler parameters measured were of statistically significant difference between (survivors & non- survivors’ groups). As the higher the tricuspid E wave the less probability to survive. At time of ICU admission, TDI for the lateral annulus of TV measured in the two groups.
Conclusion: All measurements were with significant statistical difference as the higher the Em the more probability to survive. lower Em and a higher E/Em ratio were both strongly associated with mortality in patients with severe sepsis or septic shock