Early Assessment of Fluid Tolerance (VExUS) and Stroke Volume (LVOT-VTI) to Predict Adverse Outcomes in Emergency Department Patients with Suspected Sepsis - 27/08/26

Doi : 10.1016/j.aicoj.2026.100143

Daniel M. Rolston ^a,⁎ , John P. Forrester ^b, Elizabeth A. Young ^a, Margaret Gorlin ^a, Amanda Dalpiaz ^a, Nicholas Bielawa ^a, Timmy Li ^a, Kate van Loveren ^c, Daniel Jafari ^a, Mathew Nelson ^a, Allison L. Cohen ^a

^a Northwell, New Hyde Park, New York, United States

^b Montefiore Einstein, Bronx, New York, United States

^c State University of New York Upstate Medical University, Syracuse, New York, United States

^⁎ Corresponding author at: Department of Emergency Medicine, 300 Community Drive, Manhasset, NY 11030, United States. Department of Emergency Medicine 300 Community Drive Manhasset NY 11030 United States

connectez-vous ou créez un compte

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 27 August 2026
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

To determine if early Doppler ultrasound assessments of venous congestion with Venous Excess Ultrasound (VExUS) and stroke volume with left ventricular outflow tract velocity time integral (LVOT-VTI) are associated with 24-h adverse outcomes and fluid-responsiveness in Emergency Department (ED) suspected sepsis patients prior to substantial fluid administration.

Methods

A single-center, prospective cohort study of adult ED patients with suspected sepsis recruited between 5/2020 and 12/2023 (exclusions: receipt of >500 mL fluid, intubated, on vasopressors, or existing do not resuscitate/intubate). The primary outcome was a 24-h ordinal measure of mortality, intensive care unit (ICU) admission, or rapid response team (RRT) activation; and the secondary outcome was fluid-responsiveness (increase in LVOT-VTI ≥10% after a 500 mL fluid bolus). Multivariable ordinal and multinomial regression models were used.

Results

545 patients had VExUS and 493 had LVOT-VTI measurements. 24.7% of VExUS 0 versus 56.5% of VExUS 3 patients died/admitted to ICU within 24 hours. VExUS scores ≥1 were associated with increased mortality or ICU admission: VExUS 1: OR 2.37 (95%CI: 1.29-4.36); VExUS 2: OR 2.84 (95%CI: 1.64-4.92); VExUS 3: OR 4.09 (95%CI: 2.24-7.45). VTI alone was not associated with increased adverse outcomes. 23.5% of VExUS 0/VTI ≥17 cm patients died/admitted to ICU within 24 hours versus 57.3% of VExUS 2-3/VTI <17 cm (OR 3.67 [95%CI: 2.04-6.61]). 63.7% of VExUS 0 versus 21.1% of VExUS 3 were fluid-responsive. VExUS score ≥1 were associated with decreased odds of fluid-responsiveness: VExUS 1: OR 0.35 (95%CI: 0.19-0.63); VExUS 2: OR 0.20 (95%CI: 0.11-0.37); VExUS 3 OR 0.16 (95%CI: 0.07-0.36). 62.1% of LVOT-VTIs 17-20 cm were fluid-responsiveness (OR 2.01; 95%CI: 1.20-3.37) versus 47.3% in the VTI>20 cm reference group and 45.8% in the VTI <17 cm group. 62.1% of VExUS 0/VTI ≥17 cm patients were fluid-responsive (reference) versus 16.7% of VExUS 2-3/VTI <17 cm (OR 0.16; 95% CI 0.07-0.34).

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. Combining VExUS and LVOT-VTI assessments early in sepsis may improve prediction of adverse outcomes and better characterize fluid tolerance/responsiveness to guide individualized resuscitation, but further research is needed.

Le texte complet de cet article est disponible en PDF.

Keywords : VExUS, Fluid Tolerance, Volume-Responsiveness, Fluid-Responsiveness, Sepsis, Velocity Time Integral, Stroke Volume

Plan

sstarf;

Meetings : Preliminary findings of this study were presented at the American College of Emergency Physicians national conference in Boston, MA in October, 2021 and Philadelphia, PA in October, 2023.