Relationship Between Cumulative Fluid Balance and the Degree of Venous Congestion According to VExUS Score in Critically Ill Patients in a General Intensive Care Unit.

Objectives: The Venous Excess Ultrasound Score (VExUS) assesses venous congestion using point-of-care ultrasound. While validated to predict acute kidney injury, its relationship with cumulative fluid balance and clinical edema remains unclear. This study aimed to evaluate these associations 72 hours after intensive care unit (ICU) admission.

Methods: This analytical observational cohort study included adult ICU patients with Foley catheters inserted at admission for fluid balance quantification. Patients on dialysis or with cirrhosis or abdominal hypertension were excluded. The correlation between cumulative fluid balance, edema clinical grade, and VExUS grade was analyzed. Multivariate analysis identified factors associated with significant venous congestion (VExUS grade ≥2), with statistical significance set at P < .05.

Results: A total of 123 patients were included, with a mean age of 60 years (SD ±19.2); 59.3% were male. Venous congestion (VExUS grade ≥1) was observed in 36.5% of patients, despite an average cumulative fluid balance of +0.88 L. Each liter of positive cumulative fluid balance increased the risk of significant congestion (VExUS grade ≥2) by 31% (OR = 1.31; 95% CI: 1.07-1.60). The correlation between clinical edema (Godet scale) and VExUS grade was weak (Spearman rho = 0.27), and clinical edema was not associated with significant congestion (OR = 3.22; 95% CI: 0.77-13.56).

Conclusions: In ICU patients, fluid overload is an early contributor to significant venous congestion (VExUS grade ≥2) but does not correlate with clinical edema grades, highlighting the limitations of clinical edema in assessing venous congestion.