الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Sepsis represents an emerging public health problem worldwide. Sepsis and septic shock have high rates of mortality and represent an important burden due to their social and economic costs.
Management of critically ill patients requires meticulous assessment that includes physical examination besides laboratory investigations and imaging techniques, which are essential for optimizing diagnostic and therapeutic procedures. Lung ultrasound has been used by many Intensive Care Units (ICUs) worldwide, for guiding the diagnosis and the treatment.
There is a new trend adopting lung ultrasound in the critical care setting for making its use as an extension of the clinical critical care hemodynamic monitoring, lung pathology diagnosis and other organ function assessment because of its rapid, precise detection capabilities. In addition, lung ultrasound examination has the ability to visualize the pathological changes of the organs systematically, guiding the critical care physicians to realize more details of the pathological pattern which could improve the supportive management accurately from several complicated underlying diseases.
In fact, the ultrasound method presents various advantages: it is rapid, non-invasive, available bedside technique, inexpensive and without hazard of radiation exposure and it can be repeated as necessary. In addition, ultrasound is starting to be a method used by professionals, other than radiologists, who have specific clinical questions.
Lung ultrasound (LUS) is an effective and sensitive tool compared to the traditional chest auscultation and chest X-rays. Its use as a primary survey tool in the acutely dyspneic or hypoxemic patient gives an immediate understanding of the state of the lung and influences therapeutic decisions.
Many protocols are used with lung ultrasonography such as the bedside lung ultrasound in emergency (BLUE)-protocol and the fluid administration limited by lung sonography (FALLS)-protocol which is used for hemodynamic assessment of circulatory failure, also sonographic measurement of inferior vena cava (IVC) diameter and its variation during the respiratory cycle has been increasingly used as a tool to estimate blood volume and guide fluid therapy in hemodynamically unstable patients under mechanical ventilation.
The aim of this work was to evaluate the utilization of critical care lung ultrasound score and inferior vena cava diameter in predicting outcome in septic critically ill patients.
This study was carried out on 85 patients admitted to the Critical Care Medicine Department of Alexandria Main University Hospital with sepsis or septic shock according to surviving sepsis campaign.
Assessment of patients was performed on first day of admission to intensive care unit (ICU) using lung ultrasonography (8-region method). Complete history taking, full clinical examination and records were done including routine laboratory investigations, arterial blood gases (ABG), electrocardiogram (ECG), APACHE II score, chest X ray, serum Lactate level and the Sequential Organ Failure Assessment (SOFA) score. Also, assessment of IVC diameter was done using ultrasonography and echocardiography upon admission.
Patients were followed up till hospital discharge. The primary endpoints for this study were 7-day, 28-day mortality and secondary endpoints were ICU length of stay, mechanical ventilation days and vasopressor dependence.
Regarding mortality at day 28, patients were classified into two groups:
group I: survived group included “39 patients”.
group II: non-survived group included “46 patients”.
The results showed that:
there was no significant difference between survived and non-survived group regarding age, sex and APACHE II score.
GCS show a significant increase in survived group.
There was statistically significant difference between two studied groups regarding respiratory tract infection, urinary tract infection (UTI) and soft tissue infection.
There was insignificant difference between the two studied groups regarding vital signs except the MAP that was significantly lower in non-survived group.
The urine output was significantly lower in non-survived group.
The lactate level on admission was significantly higher in non-survived group.
there was no significant difference in hypoxic index on admission between both groups.
the IVC measured by U/S was significantly positive correlated with IVC measured by Echo.
The IVC diameter by U/S was significantly increased in non-survived group.
There was a significant negative correlation between LUS total score and SOFA score.
There was a significant difference between survived and non-survived group regarding all items of LUS score in relation to outcome except RT1 that had insignificant difference between both groups.
There was a significant decrease in total LUS score in survived group than non-survived group in relation to outcome.
In our study the total lung score/24, assuming that half of total lung score (12) was the cut off value to categorize the cases into two groups regarding ICU length of stay, hospital length of stay and duration of mechanical ventilation as well as mortality at 7 and 28 days.
There was a statistically significant increase in ICU length of stay, hospital length of stay and duration of MV/day in LUSS >12 than LUSS ≤12.
The mortality was significantly higher in LUSS>12 regarding 7-day mortality as well as 28-day mortality.
At cut off value 10.0 of LUS score, The sensitivity in predicting mortality was 98.0%, specificity was 96.0% and total accuracy was 97.0%.
The cut off value for IVC diameter was 1.66cm. The IVC diameter (U/S) had a sensitivity in predicting mortality 62.0%, specificity 58.0% and accuracy 61.0%.