Proper fluid management while avoiding fluid overload can be one of the most difficult parts of practicing medicine. Unfortunately, many physicians using Point of Care Ultrasound (POCUS) mainly rely on Inferior Vena Cava (IVC) measurements to predict the “Fluid Status” (either deficient or overloaded) of their patients.<\/p>\n\n\n\n
If you are guilty of this, don’t worry, the majority of people are. It’s probably because you just didn’t have a better way to help assess the fluid status of your patients other than IVC measurements.<\/p>\n\n\n\n
However, solely using IVC measurement has many problems. IVC measurements are inaccurate because, just like central venous pressure (CVP)<\/a>, they do not accurately represent your patient’s preload in the left ventricle. The IVC can also be dilated in conditions such as valvulopathies, pulmonary hypertension, or in patients with no comorbidities (such as athletes<\/a>). Therefore a dilated IVC does not necessarily mean your patient is “fluid overloaded.” In addition, IVC dilation does not quantify the amount of venous congestion from other vital organs such as the lungs, liver, gut, and kidneys.<\/p>\n\n\n\n Most of us can agree that the development of venous congestion in the lungs (pulmonary edema) from fluid overload can lead to poor patient outcomes. This can be fairly easily seen using lung ultrasound<\/a> or chest radiography. However, few us actually know how to evaluate other organs that can be affected by venous congestion such as the liver, gut, and kidneys. This is important because understanding early signs of venous congestion can help you limit fluid administration, look for underlying causes of right heart failure, start appropriate vasopressor therapy, and decrease the risk of significant end-organ damage such as acute kidney injury. <\/p>\n\n\n\n To help us with this, doctors William Beaubien-Souligny<\/a>, Philippe Rola<\/a>, Korbin Haycock<\/a>, Rory Spiegel<\/a>, et al developed a 4-step ultrasound protocol: the Venous Excess Ultrasound (VExUS<\/em><\/span>)<\/strong> Score<\/strong> is an exam that evaluates and scores the severity of venous congestion of not just the IVC but also the liver, gut, and kidneys. You can download their VExUS book chapter at the end of this post if you wish.<\/p>\n\n\n\n Furthermore, they were able to validate the VExUS Score in a recent study<\/a> and showed a correlated increased risk of AKI with an increased grade of venous congestion syndrome (SPOILER: if you read the article, the VExUS C profile<\/span> performed the best and what is described in this post<\/em>).<\/p>\n\n\n\n However, after going through the book chapter and the research study for our trainees (ICU fellows and residents), I found that it can seem daunting or confusing for some people to try to go through all of the material. Therefore, I wanted to write up this blog post with a Downloadable PDF VExUS<\/em><\/span><\/strong><\/a> Score<\/a><\/em><\/span><\/strong> Pocket Card<\/em><\/span><\/strong><\/a> and a detailed step by step approach to help make learning how to perform the VExUS Ultrasound protocol more feasible for you! <\/p>\n\n\n\n After reading this post you will:<\/p>\n\n\n\n I want to especially thank Dr. Korbin Haycock<\/a> for reviewing this material for accuracy, please follow him on Twitter! Also a shoutout to @NephroPocus<\/a> on introducing me to a great VExUS diagram that I adapted into the PDF VExUS pocket Guide. <\/p>\n\n\n\n Alright, let’s get the VExUS Exam down! <\/p>\n\n\n\n Table of Contents<\/p>\n