Hemodynamics, fluids & transfusion
Fluid responsiveness and changes in venous congestion and lung water during volume expansion in critically ill patients: a multicentre observational study
Authors' conclusion
A fluid challenge worsened venous congestion, assessed by VExUS as well as CVP, in fluid non-responders, while it was not in fluid responders.
Study context
- Population
- Critically ill patients in 3 ICUs receiving a 500-mL fluid challenge
- Participants
- 64 patients · 3 ICUs
- Exposure
- Fluid responders vs fluid non-responders during a 500-mL fluid challenge
- FR+n = 42
- Outcome
- Changes in venous congestion (venous excess ultrasound (VExUS), central venous pressure (CVP)) and extravascular lung water index (EVLWI) during a fluid challenge according to changes in cardiac index
Methodological detailsretrospective analysis of prospectively recorded data, planned acute respiratory distress syndrome (ARDS) subgroup analysis
- Retrospective analysis of prospectively recorded data
- Planned ARDS subgroup analysis
Main finding
As reported in the abstract
VExUS grade deterioration after fluid challenge · after fluid challenge
P < 0.001
Observational data: associations, not effects.
Further findings
Abnormal VExUS grades after fluid challenge
P < 0.001
Baseline VExUS grade 0 · before fluid challenge
P = 0.601
CVP increase with fluid challenge
P = 0.064
Baseline CVP · before fluid challenge
P = 0.002
| Outcome | FR+ | FR- | P value |
|---|---|---|---|
| VExUS congestion points (0–7) after fluid challenge | 1.5 (IQR 1.0–3.0) | 4.0 (IQR 3.0–5.0) | P < 0.001 |
| Baseline VExUS congestion points · before fluid challenge | 1.0 (IQR 0.0–2.3) | 2.0 (IQR 1.0–3.0) | P = 0.053 |
| EVLWI increase, ARDS vs no ARDS, FR- (subgroup) | P = 0.046 | ||
| EVLWI increase, ARDS vs no ARDS, FR+ (subgroup) | P = 0.009 |
- Extravascular lung water index (EVLWI) increase, ARDS vs no ARDS, FR- (subgroup): ARDS 1.7 (IQR 0.9–3.3) mL/kg
- EVLWI increase, ARDS vs no ARDS, FR- (subgroup): No ARDS 0.7 (IQR 0–1.4) mL/kg
- EVLWI increase, ARDS vs no ARDS, FR- (subgroup): 25 patients with ARDS
- EVLWI increase, ARDS vs no ARDS, FR+ (subgroup): ARDS 1.0 (IQR −0.6–2.5) mL/kg
- EVLWI increase, ARDS vs no ARDS, FR+ (subgroup): No ARDS 0 (IQR −0.7–0.4) mL/kg
- EVLWI increase, ARDS vs no ARDS, FR+ (subgroup): 25 patients with ARDS
Baseline EVLWI · before fluid challenge
- Similar between groups
Original publication
Fluid responsiveness and changes in venous congestion and lung water during volume expansion in critically ill patients: a multicentre observational study. Crit Care. Published 22 January 2026. doi:10.
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