الفهرس 
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Abstract
Accurate hemodynamic monitoring is vital in the diagnosis and management of critically ill patients. The best method for monitoring remains controversial, Adequate perioperative management guided by effective monitoring can help reduce the risk of complications and thus potentially improve outcomes.
Clinical evaluation by the attended Physician observing low cardiac output signs and symptoms remains a corner stone in the assessment of haemodynamics in critically ill patients, however fluid assessment tools by both echocardiography and non-invasive cardiometry along with contractility assessment by echocardiography for both right and left ventricle potentially assists physician in his task.
In comparing echocardiography and ICON There is significant positive correlation between TAPSE, CO by echo and CI by ICON along with negative correlation between IVC collapsibility and FTC. As per clinical evaluation of low cardiac output status there was no correlation with ICON parameters, on the other hand it was seen that it is corelated with TAPSE in the 1st 6 hours assessment and with EF in the 24 hours assessment being both increased in the no low cardiac output group.
Lactate is a very important biomarker in post operative period, there was a significant decrease in lactate from the 6th hour assessment (2.3mmol/L) to the 24 hour (1.5mmol/L). It also observed in our study that lactate was negatively corelated with the total fluid content. hyperlactatemia should be considered a potent biomarker of adverse outcome and associated with higher postoperative complication.
Although BNP level decreased between 1st 6 hours and 24 hours assessment from a median range 278 to 78 there was no correlation between BNP and echocardiography in our study. On the other hand, BNP showed significant negative correlation with stroke volume variation measured by ICON.
In our study we didn’t find significant correlation between length of stay or fate of patients with ICON parameters. Although there was a positive correlation between thoracic fluid content (TFC) and time on bypass machine which may affect the duration of mechanical ventilation days.
Although there was significant correlation between TAPSE and clinical evaluation of low cardiac output clinical assessment in the 6 hours interval, there was a decrease in TAPSE in the 1st 24 hours assessment in relation to the 6 hours assessment. (from 11.2 +/- 2.1 to 10.7 +/- 1.6).