Venous Doppler to Assess Congestion: A Comprehensive Review of Current Evidence and Nomenclature

Deschamps, Jean; Denault, André; Galarza, Laura; Rola, Philippe; Ledoux-Hutchinson, Lawrence; Huard, Karel; Gebhard, Caroline E.; Calderone, Alexander; Canty, David; Beaubien‐Souligny, William

doi:10.1016/j.ultrasmedbio.2022.07.011

Cited by 20 publications

(6 citation statements)

References 63 publications

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“…The fact that VExUS was not very high and did not significantly change during the first days of ICU admission may indicate that VExUS may not be a good parameter reflecting the volume status in general ICU patients, and that these patients may have low susceptibility to develop severe systemic congestion. The VExUS was previously demonstrated to be not predictive of adequate decongestion by diuretic fluid removal [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of systemic venous congestion assessed by Venous Excess Ultrasound Grading System (VExUS) and association with acute kidney injury in a general ICU cohort: a prospective multicentric study

et al. 2023

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Background The importance of assessing venous congestion in ICU patients is widely acknowledged, but its study is hampered by the lack of a practical evaluation tool. The Venous Excess Ultrasound Grading System (VExUS), based on a semi-quantitative combined ultrasound assessment, has been associated with acute kidney injury (AKI) in cardiac ICU patients. The objectives of this study were to assess the prevalence of congestion using VExUS in general ICU patients, and to evaluate the association between VExUS, AKI and death. Methods This prospective, observational study included adult patients within 24 h of ICU admission. VExUS and hemodynamic parameters were measured four times during the ICU stay: within 24 h of ICU admission, after day 1 (between 24 and 48 h), after day 2 (between 48 and 72 h), and last day of ICU stay. The prevalence of AKI during the first week in ICU and 28-day mortality were assessed. Results Among the 145 patients included, the percentage of patients with a VExUS score of 2 (moderate congestion) and 3 (severe congestion) was 16% and 6%, respectively. The prevalence did not change over the study period. There was no significant association between admission VExUS scores and AKI (p = 0.136) or 28-day mortality (p = 0.594). Admission VExUS ≥ 2 was not associated with AKI (OR 0.499, CI95% 0.21–1.17, p = 0.109) nor 28-day mortality (OR 0.75, CI95% 0.2–2.8, p = 0.669). The results were similar for VExUS scores measured at day 1 and day 2. Conclusions In general ICU cohort the prevalence of moderate to severe venous congestion was low. Early assessment of systemic venous congestion using VExUS scores was not associated with the development of AKI or with 28-day mortality.

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Section: Discussionmentioning

confidence: 99%

Prevalence of systemic venous congestion assessed by Venous Excess Ultrasound Grading System (VExUS) and association with acute kidney injury in a general ICU cohort: a prospective multicentric study

et al. 2023

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“…Kerr and Warren discovered that cardiac fluctuations can propagate peripherally in 1925 [ 24 ]. With increases in venous load, cardiac pressure waves travel farther, causing corresponding changes in the venous blood flow spectrum known as the “ripple phenomenon.” Venous Doppler assessment can be employed to identify changes that indicate reduced systemic venous compliance [ 25 ]. The spectrum of venous blood flow will change accordingly with the severity of venous reflux disorder, whether in acute or chronic venous overload.…”

Section: Methods Of Vrs Evaluationmentioning

confidence: 99%

“…The spectrum of venous blood flow will change accordingly with the severity of venous reflux disorder, whether in acute or chronic venous overload. Ultrasonic waveform morphology of the large systemic and pulmonary veins has been suggested as an indicator of increased venous load [ 25 ]. We classified these indicators into four grades based on the extent of venous overload: grade I, normal; grade II, mild abnormality; grade III, moderate abnormality and grade IV, severe abnormality.…”

Section: Methods Of Vrs Evaluationmentioning

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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“…While a numerical scoring system, called a VeXUS score, may be used, 56 a recent excellent comprehensive review advocates for a standardized pattern-based description of the individual waveforms. 57 The evidence base behind this technique is still in evolution; increased venous congestion has been associated with worse renal outcomes in post-cardiac surgery patients and in general critically ill populations. 56 , 58 However, as of yet there are no prospective studies looking at the use of these techniques to guide decongestion therapy.…”

Section: Pocus In Renal Failurementioning

confidence: 99%

Multiorgan Point-of-Care Ultrasound Assessment in Critically Ill Adults

Hobbs

Millington

Wiskar

2023

J Intensive Care Med

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Traditional point-of-care ultrasound (POCUS) training highlights discrete techniques, single-organ assessment, and focused protocols. More recent developments argue for a whole-body approach, where the experienced clinician-ultrasonographer crafts a personalized POCUS protocol depending on specific clinical circumstances. This article describes this problem-based approach, focusing on common acute care scenarios while highlighting practical considerations and performance characteristics.

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Venous Doppler to Assess Congestion: A Comprehensive Review of Current Evidence and Nomenclature

Cited by 20 publications

References 63 publications

Prevalence of systemic venous congestion assessed by Venous Excess Ultrasound Grading System (VExUS) and association with acute kidney injury in a general ICU cohort: a prospective multicentric study

Prevalence of systemic venous congestion assessed by Venous Excess Ultrasound Grading System (VExUS) and association with acute kidney injury in a general ICU cohort: a prospective multicentric study

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

Multiorgan Point-of-Care Ultrasound Assessment in Critically Ill Adults

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