الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Patients with signs and symptoms of severe sepsis and septic shock present a clinical challenge and require early and aggressive resuscitation.
A recent consensus report defines sepsis as “life-threatening organ dysfunction caused by a dysregulated host response to infection”. Septic shock is defined as a “subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone”.
Clinical indicators of sepsis are defined by a two steps screening method. The first step should be identification of infection. The second step should be identification of organ dysfunction by the same organ dysfunction criteria, including lactate level greater than 2 mmol/L or qSOFA score more than two over three criteria.
Opinions on the causes and potential therapies for sepsis have evolved over time, including mainly dysregulated coagulopathy, hyperinflamatory response versus blunted inflammatory response, cellular dysfunction, neutrophil hyperactivity, lymphocytes apoptosis or endothelial cell failure.
Initial management according to sepsis campaign includes fluids, vasopressors, steroid, antibiotics, source control, tight glycemic control and mechanical ventilationif needed.
Traditional parameters of assessing the adequacy of resuscitation are limited, and physicians poorly predict ongoing hypoperfusion in critically ill patients. Measurement of hemodynamics is traditionally limited to pulmonary artery catheterization in the intensive care unit (ICU). Research and expert consensus recognize the potential of early hemodynamic monitoring, but also question the routine use of pulmonary artery catheters in shock. As Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics including carbon dioxide rebreathing, esophageal doppler, pulse contour analysis, echocardiography, thoracic bioempedance and electric cardiometry.
Our study was a prospective observational cohort study where we screened twenty patient to evaluate the effect of cardiac index, mean arterial blood pressure, heart rate, and oxygen delivery as measured noninvasively by impedance cardiography (ICG) in prediction of the outcome and prognosis in sepsis.
Results showed significant low cardiac index values as well as oxygen delivery values and longer hospital stay in the non-survivors group. Heart rate, mean arterial pressure arterial oxygen saturation as well as laboratory data were no statistically different between the two groups except for TLC and serum lactate; which concurs with previous studies.
The strength of this study is that it reflects the cardiac index of a broad range of critically ill patients who meet criteria for EGDT in the ED or the ICU. Our patient population is more diverse and can easily be identified by well-known inclusion criteria. Although the clinical characteristics of our patient population may differ from prior work, the incidence of an absolute low cardiac index was consistent with other studies.
Reviews have demonstrated that changes in stroke volume, cardiac output, or cardiac index are better measures of fluid responsiveness. As an initial step, we have demonstrated that noninvasive assessment of the cardiac index is feasible and that an association exists between the cardiac index on initiation of EGDT and in-hospital mortality.