Scholarlink

Background <p>The relationship between fluid responsiveness and right-and left-sided congestion remains underexplored. This study aimed to delineate the dynamic behaviour of venous congestion and extravascular lung water index (EVLWI) during a fluid challenge depending on the concomitant changes in cardiac index (CI).</p> Methods <p>In patients from three intensive care units, for whom a 500-mL fluid challenge was administered, we retrospectively analysed CI, central venous pressure (CVP), venous excess ultrasound (VExUS), and EVLWI, which had been prospectively recorded. A VExUS congestion point was calculated from 0 to 7 by assigning 1 point to each degree of abnormality for the 4 investigated veins. A subgroup analysis was planned in patients with acute respiratory distress syndrome (ARDS).</p> Results <p>We analysed 64 patients, of whom 42 (66%) were fluid responders (FR+) defined by a CI increase ≥ 15% with fluid infusion. Before the fluid challenge, CVP was lower in FR + than in fluid non-responders (FR-) (7.3 [2.9–10.3] vs. 10.6 [8.2–13.0] mmHg,respectively, <i>p</i> = 0.002). VExUS grades and congestion points were not different between FR + and FR- (Grade 0: 62% vs. 55%, respectively, <i>p</i> = 0.601; congestion points: 1.0 [0.0–2.3] vs. 2.0 [1.0–3.0], respectively, <i>p</i> = 0.053). EVLWI was also similar between groups. Following fluid administration, VExUS grade deterioration occurred in 5% of FR + versus 73% of FR− (<i>p</i> &lt; 0.001). After the fluid challenge, abnormal VExUS grades were more prevalent in FR − than in FR+ (91% vs. 43%, respectively, <i>p</i> &lt; 0.001), and congestion points were higher (4.0 [3.0–5.0] vs. 1.5 [1.0–3.0], respectively, <i>p</i> &lt; 0.001). CVP increased by 1.4 [0.4–2.4] mmHg in FR + and 2.0 [1.1–3.5] mmHg in FR- (<i>p</i> = 0.064). Among 25 patients with ARDS, EVLWI increased more than in patients without ARDS, in both FR- (by 1.7 [0.9–3.3] vs. 0.7 [0–1.4] mL/kg, respectively, <i>p</i> = 0.046) and FR+ (by 1.0 [-0.6–2.5] vs. 0 [-0.7–0.4] mL/kg, respectively, <i>p</i> = 0.009).</p> Conclusion <p>A fluid challenge worsened venous congestion, assessed by VExUS as well as CVP, in fluid non-responders, while it was not in fluid responders.</p> Graphical abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Fluid responsiveness and changes in venous congestion and lung water during volume expansion in critically ill patients: a multicentre observational study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月22日

查看全文
  • Xiang Si,
  • Daiyin Cao,
  • Rui Shi,
  • Wenliang Song,
  • Riccardo Antolini,
  • Marion Beuzelin,
  • Allegra Blandina,
  • Francesca Botta,
  • Federico Davì,
  • Giovanni Lorenzo Rumi,
  • Martina Fracazzini,
  • Marta Lauritano,
  • Riccardo La Rosa,
  • Rui Filipe Gomes,
  • Sung Yoon Lim,
  • Ronglin Chen,
  • Jianfeng Wu,
  • Xiangdong Guan,
  • Tai Pham,
  • Christopher Lai,
  • Xavier Monnet

摘要

Background

The relationship between fluid responsiveness and right-and left-sided congestion remains underexplored. This study aimed to delineate the dynamic behaviour of venous congestion and extravascular lung water index (EVLWI) during a fluid challenge depending on the concomitant changes in cardiac index (CI).

Methods

In patients from three intensive care units, for whom a 500-mL fluid challenge was administered, we retrospectively analysed CI, central venous pressure (CVP), venous excess ultrasound (VExUS), and EVLWI, which had been prospectively recorded. A VExUS congestion point was calculated from 0 to 7 by assigning 1 point to each degree of abnormality for the 4 investigated veins. A subgroup analysis was planned in patients with acute respiratory distress syndrome (ARDS).

Results

We analysed 64 patients, of whom 42 (66%) were fluid responders (FR+) defined by a CI increase ≥ 15% with fluid infusion. Before the fluid challenge, CVP was lower in FR + than in fluid non-responders (FR-) (7.3 [2.9–10.3] vs. 10.6 [8.2–13.0] mmHg,respectively, p = 0.002). VExUS grades and congestion points were not different between FR + and FR- (Grade 0: 62% vs. 55%, respectively, p = 0.601; congestion points: 1.0 [0.0–2.3] vs. 2.0 [1.0–3.0], respectively, p = 0.053). EVLWI was also similar between groups. Following fluid administration, VExUS grade deterioration occurred in 5% of FR + versus 73% of FR− (p < 0.001). After the fluid challenge, abnormal VExUS grades were more prevalent in FR − than in FR+ (91% vs. 43%, respectively, p < 0.001), and congestion points were higher (4.0 [3.0–5.0] vs. 1.5 [1.0–3.0], respectively, p < 0.001). CVP increased by 1.4 [0.4–2.4] mmHg in FR + and 2.0 [1.1–3.5] mmHg in FR- (p = 0.064). Among 25 patients with ARDS, EVLWI increased more than in patients without ARDS, in both FR- (by 1.7 [0.9–3.3] vs. 0.7 [0–1.4] mL/kg, respectively, p = 0.046) and FR+ (by 1.0 [-0.6–2.5] vs. 0 [-0.7–0.4] mL/kg, respectively, p = 0.009).

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.

Graphical abstract