ObjectivesThe aim of this study was to evaluate whether the presence of a pulsatile femoral vein pattern is and indicator of venous congestion in ICU; DesignRetrospective observational study; SettingThree medico-surgical university-affiliated ICUs; ParticipantsAdult patients who had ultrasound evaluation at several time points during ICU stay: at baseline (within 24h of admission to ICU), and/or daily during ICU stay, and/or within 24h before ICU discharge; InterventionsAt each time point, the hemodynamic, respiratory and cardiac ultrasound parameters were recorded. The common femoral vein was studied with pulsed-wave Doppler at the level of the femoral trigonum, with high frequency (5–13 MHz) linear array vascular probe and venous vascular mode, in supine patients. Measurements and Main resultsOne hundred-and-eight patients who underwent 400 ultrasound evaluations (3.7 ± 1 ultrasound evaluations per patient) during their ICU stay were included. 79/108 patients (73%) had a pulsatile femoral vein pattern at least at one timepoint. The multivariable mixed effects logistic regression model demonstrated an association between pulsatile femoral vein pattern, BMI (OR: 0.91(CI95%: 0.85-0.96), p=0.002), IVC mean diameter (OR:2.35 (CI95%: 1.18-4.66), p=0.014), portal vein pulsatility (OR: 2.3 (CI95%:1.2-4.4), p=0.012), and congestive renal vein flow pattern (OR: 4.02 (CI95%: 2.01-8.03), p<0.001). The results were confirmed by principal component analysis. ConclusionIn ICU, a pulsatile femoral vein pattern is associated with parameters of venous congestion, independently of patient's volume status, and ventilatory treatment. These results suggest the femoral vein Doppler pulsatility as a parameter of congestion in ICU patients.