ArticleAnnals of intensive care2026
Early assessment of fluid tolerance (VExUS) and stroke volume (LVOT-VTI) to predict adverse outcomes in emergency department patients with suspected sepsis.
Article in Annals of intensive care, 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: To determine if early Doppler ultrasound assessments of venous congestion with Venous Excess Ultrasound (VExUS) and stroke volume with left ventricular outflow tract velocity time integral (LVOT-VTI) are associated with 24-h adverse outcomes and fluid-responsiveness in Emergency Department (ED) suspected sepsis patients prior to substantial fluid administration. Methods: A single-center, prospective cohort study of adult ED patients with suspected sepsis recruited between 5/2020 and 12/2023 (exclusions: receipt of >500 mL fluid, intubated, on vasopressors, or existing do not resuscitate/intubate). The primary outcome was a 24-h ordinal measure of mortality, intensive care unit (ICU) admission, or rapid response team (RRT) activation; and the secondary outcome was fluid-responsiveness (increase in LVOT-VTI ≥10% after a 500 mL fluid bolus). Multivariable ordinal and multinomial regression models were used. Results: 545 patients had VExUS and 493 had LVOT-VTI measurements. 24.7% of VExUS 0 versus 56.5% of VExUS 3 patients died/admitted to ICU within 24 h. VExUS scores ≥1 were associated with increased mortality or ICU admission: VExUS 1: OR 2.37 (95%CI: 1.29-4.36); VExUS 2: OR 2.84 (95%CI: 1.64-4.92); VExUS 3: OR 4.09 (95%CI: 2.24-7.45). VTI alone was not associated with increased adverse outcomes. 23.5% of VExUS 0/VTI ≥ 17 cm patients died/admitted to ICU within 24 h versus 57.3% of VExUS 2-3/VTI < 17 cm (OR 3.67 [95%CI: 2.04-6.61]). 63.7% of VExUS 0 versus 21.1% of VExUS 3 were fluid-responsive. VExUS score ≥1 were associated with decreased odds of fluid-responsiveness: VExUS 1: OR 0.35 (95%CI: 0.19-0.63); VExUS 2: OR 0.20 (95%CI: 0.11-0.37); VExUS 3 OR 0.16 (95%CI: 0.07-0.36). 62.1% of LVOT-VTIs 17-20 cm were fluid-responsiveness (OR 2.01; 95%CI: 1.20-3.37) versus 47.3% in the VTI > 20 cm reference group and 45.8% in the VTI < 17 cm group. 62.1% of VExUS 0/VTI ≥ 17 cm patients were fluid-responsive (reference) versus 16.7% of VExUS 2-3/VTI < 17 cm (OR 0.16; 95% CI 0.07-0.34). Conclusion: In non-ventilated ED patients with suspected sepsis, VExUS scores ≥1 were associated with increased odds of 24-h mortality/ICU admission and RRT activation and decreased odds of fluid-responsiveness. Combining VExUS and LVOT-VTI assessments early in sepsis may improve prediction of adverse outcomes and better characterize fluid tolerance/responsiveness to guide individualized resuscitation, but further research is needed.
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