Background: Surgery, poly trauma, burns, stroke and pancreatitis are often accompanied bya massive activation of the immune system called systemic inflammatory response syndrome.Due to counter regulatory mechanisms such as endocrine, paracrine or autocrine actions alongwith intracellular alterations this hyper-inflammation is followed by a temporaryimmunodeficiency called compensatory anti-inflammatory response syndrome. In its mostsevere form it is also referred to as immune paralysis state. Esophogeal Doppler monitoringallows monitoring of the hemodynamic effects of ionotropic drugs and volume replacement.Thus hypotensive patients with acute circulatory failure, restoration of an adequate meanarterial pressure may be associated with changes in aortic diameter that could significantlyinfluence the circulation of aortic blood flow. If aortic diameter and flow increase with fluidloading with increasing arterial pressure then the estimated increase in aortic blood flowassuming a constant aortic diameter would be less than the true increase in aortic blood flow .Methods and results: analysis of blood samples that entered the clinical immunologicdiagnostics and of cells from in vitro model of postinflammatory immunodefficiency.Monitoring aortic blood flow by esophageal doppler. Setting: University laboratory subjects:Intensive care unit (ICU) patients at the university hospital. Methods: twenty patients weresubjected to full history taking, complete detailed clinical examination, vital signs, length ofstay, full laboratory Examination, micro-biological investigations, sofa score, measurement ofmonocyte expressive co-stimulatory factor cd86using systematic flow cytometry analysistechnique, measurement of aortic flow using esophageal Doppler monitoring in assessingfluid responsiveness, outcome classified into survivors and non- survivors. Result:hemodynamics parameters in survivors and nonb-survivors sowed a highly statisticalsiignificance as regards heart rate, temperature and respiratory rate and a statisticalsignificance as regards mean arterial blood pressure and central venous pressure. Laboratoryparameters showed a highly significant statistical difference as regards total leucocytic count,sgot, sgpt, prothrombin time, international normalized ratio, serum creatinine and a statisticaldifference as regards platelet count and serum albumin, asregards arterial blood gasesparameters PH, PCO2 showed a highly significant difference and a significant difference asregards HCO3. CD86 by percentage expression sowed insignificant difference throughout thefour days meanwhile relative intensity sowed a highly significant difference in day one, threeand four and mean fluoresence ratio showed a significant statistical difference in day one andthree and a highly significant difference in day four while in day two percentage ofexpression, mean fluoresence ratio and relative intensity all were insignificant statisticallyaortic blood flow showed a highly significant statistical difference after fluid challenge in dayone and day four as regards sofa score sowed a significant statistical difference in day one andday two; and a highly significant statistical difference in day three and four. by correlationbetween aortic blood flow in day one and sofa score in day none a near one perfect correlationbetween both parameters.Conclusion monocyte CD86 trend from day one to day three by relative intensity or meanfuoresence ratio together with aortic blood flow in day one, sofa score in day one, laboratoryparameters, vital signs and arterial blood gases parameters could be helpful diagnostic andprognostic variables in ICU patients.