ArticleThe Southern African journal of critical care : the official journal of the Critical Care Society2026
Fluid tolerance in septic shock: Femoral vein pulsatility versus VExUS score in a cross-sectional study.
Article in The Southern African journal of critical care : the official journal of the Critical Care Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Excessive fluid resuscitation in patients with septic shock is associated with acute organ injury and increased mortality. Accurate assessment of fluid tolerance is therefore essential. Right cardiac chamber fluid tolerance can be evaluated by estimating the right atrial pressure using central venous catheters, inferior vena cava (IVC) measurements, Venous Excess Ultrasound (VExUS) scores and femoral vein pulsatility (FVP). Objectives: To assess the correlation between FVP and VExUS score in evaluating fluid intolerance and venous congestion in patients with septic shock; the correlation of FVP and VExUS score with central venous pressure (CVP); and to evaluate the effect of positive pressure ventilation on the relationship between FVP and VExUS score. Methods: In this observational cross-sectional study, 80 participants were assessed for fluid tolerance using VExUS scores and FVP. CVP, maximum and minimum IVC diameters and IVC dynamicity were regarded as the gold standard and used as reference. Results: FVP showed moderate agreement with VExUS score (Kappa=0.55; p<0.001). Both FVP and VExUS score demonstrated the ability to predict CVP values ≥17 cmH Conclusion: A pulsatile femoral vein pattern indicates fluid intolerance in patients with septic shock, providing an additional marker for assessing fluid status. Doppler assessment of the femoral vein offers advantages of easier anatomical accessibility and a shorter learning curve compared with other methods. Contribution of the study: This study evaluated a simple rapid tool (femoral vein pulsability) in assessing volume state and fluid tolerance in septic patients in comparison with VExsus.
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