Early assessment of fluid tolerance (Venous Excess Ultrasound (VExUS)) and stroke volume (left ventricular outflow tract velocity time integral (LVOT-VTI)) to predict adverse outcomes in emergency department patients with suspected sepsis
Authors' 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.
Study context
- Population
- Adult Emergency Department (ED) patients with suspected sepsis before substantial fluid administration (excluded: >500 mL fluid, intubated, on vasopressors, do not resuscitate/intubate), 5/2020–12/2023493 with LVOT-VTI
- Participants
- 545 patients
- Exposure
- VExUS scores 1, 2, 3 vs VExUS 0; LVOT-VTI categories
- Outcome
- Ordinal measure of mortality, ICU admission or rapid response team activation
- Follow-up
- 24 h
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Death/ICU admission
Each group vs VExUS 0Odds ratio (95% CI)
VExUS 1
2.37(1.29–4.36)
VExUS 2
2.84(1.64–4.92)
VExUS 3
4.09(2.24–7.45)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | VExUS 0 | VExUS 3 | OR (95% CI) | |
|---|---|---|---|---|
| Death/ICU admission, combined VExUS/VTI · 24 hVExUS 2-3/VTI < 17 cm vs VExUS 0/VTI ≥ 17 cm | 3.67 (2.04–6.61) | |||
| Fluid-responsiveness (LVOT-VTI increase ≥10% after 500 mL bolus) by VExUSVExUS 1 vs VExUS 0 | 63.7% | 21.1% | 0.35 (0.19–0.63) | |
| Fluid-responsiveness (LVOT-VTI increase ≥10% after 500 mL bolus) by VExUSVExUS 2 vs VExUS 0 | 0.20 (0.11–0.37) | |||
| Fluid-responsiveness (LVOT-VTI increase ≥10% after 500 mL bolus) by VExUSVExUS 3 vs VExUS 0 | 0.16 (0.07–0.36) | |||
| Fluid-responsiveness by LVOT-VTIVTI 17-20 cm vs VTI > 20 cm | 2.01 (1.20–3.37) | |||
| Fluid-responsiveness, combined VExUS/VTIVExUS 2-3/VTI < 17 cm vs VExUS 0/VTI ≥ 17 cm | 0.16 (0.07–0.34) | |||
| 0.050.21520Odds ratio (log scale) |
- Death/intensive care unit (ICU) admission, combined VExUS/VTI: VExUS 0/VTI ≥ 17 cm 23.5%
- Death/ICU admission, combined VExUS/VTI: VExUS 2-3/VTI < 17 cm 57.3%
- Fluid-responsiveness by LVOT-VTI: VTI 17-20 cm 62.1%
- Fluid-responsiveness by LVOT-VTI: VTI > 20 cm 47.3%
- Fluid-responsiveness by LVOT-VTI: VTI < 17 cm 45.8%
- Fluid-responsiveness, combined VExUS/VTI: VExUS 0/VTI ≥ 17 cm 62.1%
- Fluid-responsiveness, combined VExUS/VTI: VExUS 2-3/VTI < 17 cm 16.7%
Original publication
Early assessment of fluid tolerance (VExUS) and stroke volume (LVOT-VTI) to predict adverse outcomes in emergency department patients with suspected sepsis. Ann Intensive Care. Published 26 August 2026. doi:10.
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