Evaluación ultrasonográfica de la congestión venosa

Aplicación del venous excess ultrasound score (VExUS) a la práctica clínica en medicina interna

Abstract

Evaluating volume status is crucial in managing both critically ill and non-critically ill patients, as volume overload can lead to venous congestion, microvascular dysfunction, and organ damage. Various clinical and paraclinical strategies exist to assess venous congestion, among which Point-of-Care Ultrasound (POCUS) stands out as a versatile, accessible, and easy-to-perform method.

Several protocols have been developed to evaluate venous overload, notably the Venous Excess Ultrasound Score (VExUS). The VExUS is a four-step assessment that involves measuring the inferior vena cava and utilizing pulsed Doppler on the hepatic veins, the portal vein, and intrarenal vessels to evaluate flow patterns. Based on these measurements, venous congestion is classified into VExUS grades ranging from 0 (no congestion) to 3 (severe congestion). Volume overload determined by the VExUS strategy has been shown to correlate with unfavorable clinical outcomes, including acute kidney injury and the need for vasopressors (HR 2.82, 95% CI 1.21-6.55, p=0.02), demonstrating a specificity of 96% and a positive likelihood ratio (+LR) of 6.37, particularly in patients undergoing cardiovascular surgery.

Utilizing the VExUS protocol facilitates early identification and effective management of congestion, reducing the time needed to detect congestion and organ injury and guiding treatments such as depletive therapy