Impact of combining assessment of venous congestion along with fluid responsiveness on acute kidney injury parameters in septic shock: a prospective, observational study

This is a prospective, single-center observational study conducted in the Medical ICU at AIIMS Bhopal to evaluate whether combining venous congestion assessment using VExUS score with standard fluid responsiveness assessment can help identify impending fluid overload and prevent acute kidney injury in adults with septic shock. Approximately 100 patients aged 18 years or older with septic shock, with or without KDIGO stage 1–2 AKI, will be enrolled over 18 months. Patients with KDIGO stage 3 AKI, end-stage renal disease on dialysis, significant valvular heart disease, right-heart failure, inadequate ultrasound window, pregnancy, Child-Pugh C cirrhosis, or life expectancy less than 24 hours will be excluded. Each participant will undergo a single time-point assessment using tidal volume challenge and pulse pressure variation for fluid responsiveness, and ultrasound-based VExUS grading assessing IVC, hepatic, portal, and intrarenal Doppler. Patients will be categorized based on fluid responsiveness and congestion status; treatments received will follow routine ICU care. The primary outcome is development of AKI on day 7. Secondary outcomes include fluid overload, ICU length of stay, duration of mechanical ventilation, and 28-day mortality. Data will be collected from routine hospital records and confidentiality will be maintained.