Role of Echocardiography and Ultrasound Indices in Resuscitation of Septic Shock Patients

Inclusion Criteria: * ▪ Age:18-50 years old * Sex: both males \&females. * Patients diagnosed with septic shock according to SOFA score more than or equal 1 * Presence of at least one sign of acute circulatory failure from: 1. Low blood pressure (mean arterial pressure \<65 mmHg and / or systolic \<90 mmHg). 2. Tachycardia\> 120 bpm without other obvious cause of circulatory failure. 3. Oliguria \<1 ml / kg during the last hour suggestive of circulatory failure. 4. Blood hyperlactatemia \> 2mmol / l without other obvious cause a systemic circulatory failure. 5. Another sign justifying, for example vascular increase capillary refill time more than 2 seconds. Exclusion Criteria: * ▪ Known significant valvular heart disease (sever aortic insufficiency or stenosis) * Known carotid artery stenosis \>50% or previous carotid surgery * Clear contraindication to the carotid artery Doppler such as wound or infection or complete or partial occlusion of the carotid artery. * Arrhythmias affect stroke volume assessment (atrial fibrillation, frequent PVCs) * Dilated cardiomyopathy. * Poor transthoracic echocardiographic window * Patient refusal