Venous excess ultrasound score-guided fluid resuscitation versus conventional fluid resuscitation in sepsis and septic shock patients—a case control study

Abstract

Background
Accurate assessment of a patient’s volume status is essential for appropriate fluid resuscitation in sepsis and septic shock patients. Venous Excess Ultrasound Score (VExUS) is a technique that can assist in managing fluid therapy and identifying venous congestion.


Methods
This study aims to compare the effect of fluid resuscitation based on the surviving sepsis campaign recommendations (SSC) versus fluid resuscitation based on VExUS score findings in patients with sepsis and septic shock. One hundred twelve patients who were critically ill were enrolled in this randomized case–control trial. Patients were followed during hospitalization for mortality as a primary outcome, ICU length of stay, and IV fluid-related complications; acute kidney injury (AKI), the need for renal replacement therapy (RRT), respiratory failure (RF), and the need for mechanical ventilation (MV) as secondary outcomes.


Results
This study included 73 males and 39 females, with a mean age of 66.58 ± 12.39 years. The cumulative fluid balance was significantly lower in the VExUS group (n = 56) compared to the conventional group (n = 56) (− 1.58 ± 4.19 L vs. 1.43 ± 4.71 L, p = 0.001). The mortality rate was lower in the VExUS group than in the conventional group with no statistical significance difference (51.8% for conventional and 42.9% for VExUS, p = 0.344). The VExUS group showed fewer complications, such as AKI (10.7%), RRT (3.6%), and RF (25%), compared to the conventional group, which had rates of 30.4%, 21.4%, and 48.2%, respectively. The length of mechanical ventilation varied significantly between the two groups, with the VExUS group having 4.29 ± 3.36 days, while the conventional group had 7.19 ± 5.34 days (p = 0.01). Patients in the VExUS group had a shorter ICU stay, with 7.93 ± 3.63 days, compared to 11.12 ± 6.0 days in the conventional group (p = 0.001). The total hospital stay was reduced in the VExUS group, 10.04 ± 4.52 days, in contrast to 14.36 ± 7.30 days in the conventional group (p < 0.001). Higher VExUS grades were strongly associated with increased mortality.


Conclusion
VExUS-guided fluid resuscitation is a beneficial approach to managing patients with sepsis and septic shock, particularly in terms of fluid balance and associated complications. It is an easy, cheap, and readily available bedside technique that guides IVF resuscitation. Continued investigation into its utility and outcomes is warranted to confirm these findings and optimize treatment protocols for critically ill patients.