Portal vein pulsatility index is a marker of venous congestion evaluated by point of care ultrasound. It is associated with acute kidney injury, especially in critically ill patients. It may be considered as a dynamic marker. The investigators hypothesized that portal vein pulsatility index is higher after a fluid challenge only in patient without preload dependence in critically ill patients with cardiovascular insufficiency.

Inclusion Criteria:

• vasopressor requirement to maintain mean arterial pressure >65mmHg AND

• at least one of the following criteria:

  • arterial lactate >2mmol/L;
  • capillary refill time >3s;
  • mottling score >1;
  • diuresis <0,5mL/h for more than 6hours.

Exclusion Criteria:

• Diameter of vena cava <20mm
• Cirrhosis
• Pregnancy
• Severe acute pulmonary edema
• Phototype 4 or 5
• Patient opposition to participate

Adult intensive care patients with both grade 1 or higher venous congestion (VeXus C criteria) and acute circulatory failure.