Evaluation of fluid overload in Septic patients admitted to intensive care unit with Combined Venous Excess Lung Ultrasound (VExLUS) Score

Hemodynamic management in critically ill septic patients has been traditionally focused on maintaining adequate cardiac output and arterial blood pressure by relying on fluid administration along with vasopressor and inotropic support. However, administration of fluid may lead to venous congestion compromising the organ perfusion which can be overlooked as a hemodynamic parameter on clinical assessment, and could be of utmost importance in management. Point of care ultrasound (POCUS) at  bedside allows the clinician to assess the status of intravascular volume and rule out portal, intrarenal  and pulmonary fluid overload. The correlation of  modified lung ultrasound score and extravascular fluid is a well-known parameter for the assessment of the global fluid status of the patient. Adding a lung ultrasound score to VExUS grading is a novel concept. Lung ultrasound evaluates 6 different lung areas,looking at B lines and graded 0,1,2,3. VExUS protocol evaluates the amount of venous congestion in the abdominal organs, specifically by scanning the portal, hepatic, and intra-renal veins. Doppler interrogation of these vessels yields a specific pattern corresponding to a level of venous congestion: normal, mild, or severe. By combining   modified lung ultrasound score and  VExUS grading, might lead to improvement in the sensitivity of early  fluid overload detection.This is a kind of study to evaluate the VExLUS grades in earlier identification of fluid overload in septic patients.