Perioperative Venous Excess Ultrasound Score (VExUS) to Guide Decongestion in a Dilated Cardiomyopathy Patient Presenting for Urgent Surgery

Singh, Keevan; Carvalho, R. Fiorin

doi:10.7759/cureus.20545

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…The use of bedside Doppler ultrasonography to measure VRS may be effective for evaluating organ perfusion, assessing the hemodynamic response to fluid administration [ 59 , 60 ], detecting RVD, and predicting outcomes in critically ill patients, including occurrence of AKI [ 15 , 29 ], length of hospital stay, and mortality [ 7 ]. Bedside ultrasonography can guide treatment and be used to monitor the effects of diuretic therapy [ 61 ]. Although case reports have suggested the potential benefits of dynamically monitoring venous reflux disorders to improve patient outcomes, there is a scarcity of prospective randomized controlled studies in this field.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Venous Reflux Status Evaluation in the Intensive Care Unit

2024

Aging dis

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The current management approach for critically ill patients emphasizes maintaining adequate cardiac output and mean arterial pressure. Recently, researchers have increasingly emphasized the clinical significance of venous reflux. Bedside venous Doppler ultrasonography offers continuous, dynamic, and quantifiable assessment of the venous reflux status. In this review, we explore the pertinent literature on assessing the venous reflux status in critically ill patients. We propose a bedside ultrasonographic evaluation method that starts with the hepatic veins and progresses to the portal, renal and intrarenal, femoral, and pulmonary veins. The clinical significance of venous reflux status evaluation is discussed in terms of its effect on right ventricular function, the functioning of other organs, and the guidance of fluid therapy. Overall, we underscore the importance of venous reflux status evaluation in critically ill patients and highlight the benefits of incorporating bedside ultrasonography for the continuous monitoring of venous return.

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Section: Discussionmentioning

confidence: 99%

The Importance of Venous Reflux Status Evaluation in the Intensive Care Unit

2024

Aging dis

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“…Another study of 33 critically-ill children showed a significant correlation between VExUS grade and CVP [50 ▪ ]. There has been only one case report in the surgical literature, describing the successful use of VExUS for decongestion of a patient with congenital cardiomyopathy [51]. A recent case series reviewed the rationale and supporting evidence for broader application of VExUS in a variety of clinical settings [52].…”

Section: Venous Excess Ultrasound ‘Vexus’ Gradesmentioning

confidence: 99%

Monitoring the venous circulation: novel techniques and applications

Longino,

Martin,

Douglas

2024

Current Opinion in Critical Care

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Purpose of review Venous pressure is an often-unrecognized cause of patient morbidity. However, bedside assessment of PV is challenging. We review the clinical significance of venous pressure measurement, existing techniques, and introduce the Venous Excess Ultrasound (VExUS) Score as a novel approach using doppler ultrasound to assess venous pressure. Recent findings Studies show clear associations between elevated venous pressure and adverse outcomes in critically ill patients. Current venous pressure measurement techniques include physical examination, right heart catheterization (RHC), two-dimensional ultrasound, and a variety of labor-intensive research-focused physiological maneuvers. Each of these techniques have specific shortcomings, limiting their clinical utility. To address these gaps, Beaubien-Souligny et al. introduced the VExUS Score, a novel doppler ultrasound-based method that integrates IVC diameter with doppler measurements of the hepatic, portal, and renal veins to generate a venous congestion assesment. Studies show strong correlations between VExUS score and RHC measurements, and well as an association between VExUS score and improvement in cardiorenal acute kidney injury, diuretic response, and fluid status shifts. However, studies in noncardiac populations have been small, heterogenous, and inconclus ive. Summary Early studies evaluating the use of doppler ultrasound to assess venous congestion show promise, but further research is needed in diverse patient populations and clinical settings.

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“…A potential limitation of VExUS is its use in chronic liver disease wherein low hepatic pulsatility can be present even with significant systemic congestion. In the perioperative setting, this can help guide decongestive therapy in patients with heart failure, facilitate the management of right ventricular dysfunction, and potentially reduce the risk of postoperative acute kidney injury and pulmonary edema 87,91,92 .…”

Section: Venous Excess Ultrasound Score (Vexus)mentioning

confidence: 99%