218: VENOUS EXCESS ULTRASOUND SCORE (VEXUS) GUIDED FLUID MANAGEMENT IN SEPTIC SHOCK: A PILOT TRIAL

Introduction: Goal-directed resuscitation and deresuscitation in patients with septic shock requires a reliable approach to monitoring a patient's volume status. Serial assessments of the venous excess ultrasound score (VExUS) can identify venous congestion and help guide fluid management but has not been studied in a randomized trial. We conducted a pilot randomized controlled trial to study the feasibility of VExUS-guided fluid management in adult patients with septic shock. Methods: Participants in septic shock at an academic intensive care unit (ICU) were enrolled between April 2021 and February 2023 and randomized to the intervention (VExUS-guided fluid management) or control arm (usual care). Ultrasounds were performed daily on all patients. For participants in the VExUS arm, the care team was informed of the ultrasound results and given a recommendation regarding fluid management for that day. The primary study outcome was net fluid balance between time of study enrollment and day five, or at the time of ICU discharge. Secondary outcomes included incidence of acute kidney injury (AKI), respiratory failure, ICU and hospital length of stay, hospital mortality and 30-day mortality. Results: We enrolled 19 participants, 12 (63%) were randomized to the VExUS arm. The net fluid balance in the VExUS arm was -65 mL (IQR -1,733 to 2,016) and 2,608 mL (IQR -435 to 4,460) in the control arm (p=0.21). AKI and respiratory failure occurred in two (17%) and three (25%) participants in the VExUS arm versus three (43%) and five (71%) in the control arm, respectively. ICU and hospital length of stay was 66 hours (IQR 41 to 104) and 180 hours (IQR 94 to 306) in the VExUS arm versus 56 hours (IQR 44 to 150) and 165 hours (IQR 131 to 187), respectively. Hospital and 30-day mortality in the VExUS arm was 8% and 25% versus 43% and 57% in the control arm, respectively. Conclusions: Our pilot study demonstrates that VExUS-guided fluid management is feasible in patients with septic shock, and can help reduce the amount of intravenous fluid administered to patients with septic shock, compared to usual care. The positive fluid difference of 2,673 mL between the two arms suggest that the VExUS may help guide fluid management in patients with septic shock.