Observational studyCritical care (London, England)2026
Fluid responsiveness and changes in venous congestion and lung water during volume expansion in critically ill patients: a multicentre observational study.
Observational study in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Integrated haemodynamic monitoring of fluid responsiveness and fluid tolerance in critical care: from physiology to bedside applications.Journal of clinical monitoring and computing · 2026Review
- The usual suspects: a pragmatic framework to identify and address reversible contributors in apparent refractory septic shock.Critical care (London, England) · 2026Review
- Assessing fluid responsiveness in mechanically ventilated patients with intra-abdominal hypertension: a two-center, prospective, observational study.Critical care (London, England) · 2026Observational
- A Guyton-based hypothesis for venous congestion.The ultrasound journal · 2026Article
- Dynamic indices of fluid responsiveness: physiological basis and clinical limits.Intensive care medicine · 2026Article
- Central Venous Pressure Revisited: Physiology, Pitfalls, Misconceptions, and Modern Clinical Interpretation in Critical Care.Journal of clinical medicine · 2026Review
- VExUS versus CVP for assessing venous congestion: oasis or mirage?Critical care (London, England) · 2026Article
- Early assessment of fluid tolerance (VExUS) and stroke volume (LVOT-VTI) to predict adverse outcomes in emergency department patients with suspected sepsis.Annals of intensive care · 2026Article
- Venous congestion in critical care: combining VExUS, lung ultrasound, and echocardiography.Annals of intensive care · 2026Article
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Authors and funding
21 authors.
Funding
Abstract
backgroundThe relationship between fluid responsiveness and right-and left-sided congestion remains underexplored. This study aimed to delineate the dynamic behaviour of venous congestion and extravascular lung water index (EVLWI) during a fluid challenge depending on the concomitant changes in cardiac index (CI).
methodsIn patients from three intensive care units, for whom a 500-mL fluid challenge was administered, we retrospectively analysed CI, central venous pressure (CVP), venous excess ultrasound (VExUS), and EVLWI, which had been prospectively recorded. A VExUS congestion point was calculated from 0 to 7 by assigning 1 point to each degree of abnormality for the 4 investigated veins. A subgroup analysis was planned in patients with acute respiratory distress syndrome (ARDS).
resultsWe analysed 64 patients, of whom 42 (66%) were fluid responders (FR+) defined by a CI increase ≥ 15% with fluid infusion. Before the fluid challenge, CVP was lower in FR + than in fluid non-responders (FR-) (7.3 [2.9-10.3] vs. 10.6 [8.2-13.0] mmHg,respectively, p = 0.002). VExUS grades and congestion points were not different between FR + and FR- (Grade 0: 62% vs. 55%, respectively, p = 0.601; congestion points: 1.0 [0.0-2.3] vs. 2.0 [1.0-3.0], respectively, p = 0.053). EVLWI was also similar between groups. Following fluid administration, VExUS grade deterioration occurred in 5% of FR + versus 73% of FR- (p < 0.001). After the fluid challenge, abnormal VExUS grades were more prevalent in FR - than in FR+ (91% vs. 43%, respectively, p < 0.001), and congestion points were higher (4.0 [3.0-5.0] vs. 1.5 [1.0-3.0], respectively, p < 0.001). CVP increased by 1.4 [0.4-2.4] mmHg in FR + and 2.0 [1.1-3.5] mmHg in FR- (p = 0.064). Among 25 patients with ARDS, EVLWI increased more than in patients without ARDS, in both FR- (by 1.7 [0.9-3.3] vs. 0.7 [0-1.4] mL/kg, respectively, p = 0.046) and FR+ (by 1.0 [-0.6-2.5] vs. 0 [-0.7-0.4] mL/kg, respectively, p = 0.009).
conclusionA fluid challenge worsened venous congestion, assessed by VExUS as well as CVP, in fluid non-responders, while it was not in fluid responders.
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