This Study Compares Two Noninvasive Dynamic Tools: Lung Ultrasound and Transthoracic Echocardiography Using LVOT VTI. It Aims to Measure the Sensitivity and Specificity of LUS in Guiding Fluid Resuscitation and Early Detection of Fluid Responsiveness and to Prevent Volume Overload

Early detection of fluid accumulation syndrome in septic shock patients using velocity time integral. To decrease the incidence of fluid accumulation syndrome.

• To assess the feasibility and time required for each imaging modality in guiding fluid resuscitation.
• Comparison of the time required for point-of-care lung ultrasound versus LVOT-VTI to guide fluid resuscitation decisions.

To assess the sensitivity and specificity of lung ultrasonography (B-Lines) in predicting fluid non responsiveness in septic shock patients

Inclusion criteria

• Adult patients aged ≥ 18 years with septic shock.
• Mean arterial pressure (MAP) <65 mmHg.
• Need fluid resuscitation.

Exclusion criteria

• Patient <18 years.
• Refusal of patient or relative to participate in the study.
• Other types of shock.
• Morbid obesity.
• Valvular heart disease including severe aortic and mitral stenosis) and (severe aortic and mitral regurgitation).

7.Patients with heart failure with preserved or reduced Ejection fraction. 8.Burn patients. 9.End stage renal disease with regular hemodialysis patient. 11.Patients with massive pleural effusion. 12. patients with septic cardiomyopathy. 13.patients with massive ascites. 14. patient on high positive end expiratory pressure or with acute respiratory distress syndrome (ARDS). 15. Patients with right ventricular failure & pulmonary hypertension. 16. Patients with pneumonia and interstitial lung diseases. 17. Ventilated patients. 18. Poor echo window patients.