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Review
. 2025 Aug 23.
doi: 10.1007/s40477-025-01072-1. Online ahead of print.

Utilization of left ventricular outflow tract velocity time integral in the assessment of fluid responsiveness in adult patients with sepsis or septic shock - a systematic review

Stephin Zachariah Saji #  1 , Olivia Murga #  2 , Swati Khurana  3 , Bui Hung Phan  4 , Bana Khalil  5 , Amina Mustafa Nagra  6 , Steysi Falcon Aragon  7 , Deekksha Kolagatla  8 , Victor Sebastian Arruarana  9 , Domenica A Herrera  10 , Samer Kottiech  11 , Ernesto Calderón Martínez  12
Affiliations
Review

Utilization of left ventricular outflow tract velocity time integral in the assessment of fluid responsiveness in adult patients with sepsis or septic shock - a systematic review

Stephin Zachariah Saji et al. J Ultrasound. .

Abstract

Background: Sepsis and septic shock are life-threatening conditions driven by dysregulated host responses to infection, resulting in multi-organ dysfunction. While early fluid resuscitation is essential, both fluid overload and under-resuscitation can worsen outcomes. Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) has emerged as a non-invasive echocardiographic tool to assess fluid responsiveness. This systematic review evaluates the diagnostic performance, cutoff values, and limitations of LVOT VTI as a tool for assessing fluid responsiveness in adult patients with sepsis or septic shock.

Methods: A systematic search of PubMed, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL was conducted through April 13, 2025, following PRISMA 2020 guidelines (PROSPERO ID: CRD420251036927). Eligible studies used transthoracic or transesophageal echocardiography to measure LVOT VTI and assessed changes following passive leg raise (PLR) or volume expansion tests (VET). Fluid responsiveness was defined as a ≥ 10-15% increase in VTI.

Results: Three observational studies including 199 adult patients (20 with sepsis, 179 with septic shock) met inclusion criteria. Two studies used VET (500 mL saline), and one used PLR. Optimal LVOT VTI cutoffs ranged from > 7% to 16%, with sensitivity 78-96%, specificity 91-100%, and AUCs 0.84-0.99. Based on the Newcastle-Ottawa Scale, two studies were rated good quality, and one was fair.

Conclusion: LVOT VTI is a reliable, non-invasive parameter for assessing fluid responsiveness in sepsis and septic shock. Despite limited data, this review supports its integration into bedside fluid management protocols to guide individualized resuscitation strategies.

Prospero registration id: CRD420251036927.

Keywords: Echocardiography; Fluid challenge test; Fluid responsiveness; Left ventricular outflow tract velocity–time integral; Sepsis; Septic shock.

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Conflict of interest statement

Declarations. Conflict of interest: All authors declare no conflict of interest. Ethical approval: Given that this meta-analysis utilized previously published data from studies that had already obtained ethics approval and consent to participate, no additional ethics approval or consent was required for this research. Consent for publication: All authors have provided their consent for publication.

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References

    1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C et al (2021) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. https://doi.org/10.1007/s00134-021-06506-y - DOI - PubMed - PMC
    1. Singer M, Deutschman CS, Seymour C, Shankar-Hari M, Annane D, Bauer M et al (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. https://doi.org/10.1001/jama.2016.0287 - DOI - PubMed - PMC
    1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR et al (2020) Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of disease study. Lancet. https://doi.org/10.1016/S0140-6736(19)32989-7 - DOI - PubMed - PMC
    1. Self WH, Semler MW, Bellomo R, Brown SM, deBoisblanc BP, Exline MC et al (2018) Liberal versus restrictive intravenous fluid therapy for early septic shock: rationale for a randomized trial. Ann Emerg Med. https://doi.org/10.1016/j.annemergmed.2018.03.039 - DOI - PubMed - PMC
    1. Brown RM, Semler MW (2019) Fluid management in sepsis. J Intensive Care Med. https://doi.org/10.1177/0885066618784861 - DOI - PubMed - PMC

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