Abstract
INTRODUCTION: Sepsis is a dysregulated inflammatory response to an infection that may result in septic shock. In the initial phase of septic shock, large quantities of fluid are to be administered which may result in venous congestion. Venous congestion may result in organ dysfunction. Cumulative fluid balance is used as a crude method for assessing venous congestion. In our study, a new monitoring tool, the VEXUS score is used to look for its correlation with cumulative fluid balance. OBJECTIVES: To evaluate the correlation between venous excess ultrasound (VExUS) score with cumulative fluid balance. To assess the relationship between venous excess ultrasound (VExUS) score Sequential Organ Failure Assessment score, ICU mortality, and ICU length of stay. MATERIALS AND METHODS: A single-centered prospective observational study was conducted, focusing on patients diagnosed with septic shock and admitted to the medical intensive care unit. Enrollment of patients into the study was followed by treatment per departmental policy, guided by the Surviving Sepsis Campaign guidelines. Fluid management was determined by the treating physician's discretion. The venous excess ultrasound (VExUS) scan and cumulative fluid balance were recorded on the 1(st), 7(th), and 14(th) day of admission. Additionally, the Acute Physiology And Chronic Health Evaluation (APACHE), duration of length of ICU stay and ICU survival outcomes were documented for each patient. RESULTS: In this study conducted on 150 ICU patients with septic shock, 47 were ultimately included in the analysis. The demographic composition of this group revealed a predominance of males, accounting for 63.8%, with an average age of 56.48 years. Among the survivors(20) vs non survivors(27) the average age was 57 years vs 56.11yrs, average SOFA score was 6.65 vs 9.03, and average APACHE score was 25.6 vs 23.9 upon admission. Cumulative fluid balances among survivors and non survivors was 1651.7ml vs 1928ml, 5710.5ml vs 5007.2ml and 5432ml vs 8152ml on days 1, 7 and 14 respectively. The distribution of VExUS scores showed significant changes over the course of the days. On the first day, 75% of patients had a score of 0, but by day 14, this number increased to 88.8%. Notably, in multivariate analysis, the VExUS score showed a correlation with cumulative fluid balance on day 1, but this correlation did not hold on days 7 and 14. Finally, the mean duration of ICU stay differed between survivors and non-survivors, being 6 days and 9.18 days, respectively. Box plot showing correlation between VEXUS score and Cumulative fluid balance. CONCLUSION: The study indicates that the VExUS score reliable indicator of venous congestion in septic shock patients in ICU, but only on the first day of admission.