الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Intravascular volume management in the critically ill patients improves outcome; yet achieving optimal volume status remains challenging. Recent guidelines support the use of aggressive resuscitation in the early phases of critical illness [1, 2]; however; an excessively positive fluid balance independently impacts patient outcomes, including mortality and length of stay [3, 4]. • Using physiologic targets allows precise titration of the volume prescription for the critically ill [6, 7]. chronic fluid overloading frequently occurs in hemodialysis patients, so volume assessment during hemodialysis is a primary, and often a challenging, goal of physicians. • Renal replacement therapy is frequently required in critically ill patients with acute kidney injury. Large volumes of fluid need to be removed over a relatively short period of time during intermittent hemodialysis jeopardizing hemodynamic stability in already hemodynamically compromised patients. Established methods of dry weight estimation are not practical in critical care settings and the estimation of excess body fluid removable by hemodialysis constitutes a particular change in these patients [322]. • Ultrasound determination of IVC diameter has been used to monitor volume unloading during hemodialysis to better recognize patients at risk of intradialytic hypotension [10, 11]. • Lung ultrasound has recently been shown to be a useful, noninvasive technique for the assessment of extravascular lung water [2]. • Mitral inflow velocities, both peak early diastolic velocity (E) and late diastolic velocity (A), are commonly used to determine patterns of diastolic dysfunction and can also be used to serially monitor LAP. The mitral E wave represents the LA-LV gradient during early diastole and thus is preload dependent. • The aim of our study was to demonstrate whether fluid removal has an impact on IVC dimensions, peak early diastolic mitral velocity (E wave) and sonographic B lines in hemodialysis patients and evaluate the possibility of using these parameters as bedside indicators of adequate fluid removal in hemodialysis patients. • It also aimed at demonstrating whether ultrasound measurement of the IVC, peak E-velocity and B-lines can help in assessing volume subtraction while preventing hypotension. • Our study was conducted on 40 patients receiving maintenance hemodialysis admitted to the critical care department in Beni-Suef University hospital from December 2019 to December 2020. • We performed sonographic examinations three times, just after the start, in the middle (for example, 2 h after the start of hemodialysis therapy if the treatment time is 4 h), and just before the end of the hemodialysis therapy. Changes in the IVC dimensions, peak E-velocity and B-lines were recorded. • Our study showed that IVCD decreased significantly during the hemodialysis session. The degree of decline during the first half of the session was significantly higher in comparison to the second half of the session with a p value < 0.001. • Also, it showed that E-velocity decreased significantly during the hemodialysis session. The degree of decline during the first half of the session was significantly higher in comparison to the second half of the session with a p value < 0.001 • Our study showed that LUS decreased significantly during the hemodialysis session. The degree of decline during the second half of the session was significantly higher in comparison to the first half of the session with a p value < 0.001. • Also, it showed a significant moderate correlation between oxygen saturation at the end of the session and degree of decrease of LUS with a p value 0.015 while it showed a significant weak correlation between oxygen saturation and degree of decrease of both IVC diameter and E velocity with p value 0.045 and 0.048 respectively.