Critical Care · Sepsis · Clinical Pearl
A plethoric IVC can mean congestion without proving fluid responsiveness
Lede: IVC size answers a different question when used for congestion than when used to predict fluid responsiveness.
Why it matters
Respiratory IVC variation is often unreliable for predicting responsiveness in patients with spontaneous effort, low tidal volume, or altered intra-abdominal pressure. But a plethoric IVC combined with abnormal hepatic, portal, and intrarenal venous Doppler can still contribute to a VExUS-based assessment of systemic venous congestion.
The pearl
Do not use the same ultrasound finding to answer two different physiologic questions. IVC variation may fail as a responsiveness test while still contributing to a congestion assessment.
