Critical Care and Shock

Venous excess ultrasound score in patients with sepsis and cardiorenal syndrome

Abstract

Background: Fluid overload and venous congestion are deleterious in critically ill patients with cardiorenal syndrome. There is scarce literature on venous excess ultrasound score (VExUS) assessment characteristics in cardiorenal syndromes with hypoxia and sepsis.

Methods: This study was an observational, prospective, single-center study that included patients with sepsis and heart failure who were transferred to the cardiac care unit (CCU). An intensivist in critical care ultrasound performed a serial ultrasound examination until acute kidney injury (AKI) was resolved or the patient was initiated on dialysis. VExUS, comprising the inferior vena cava, hepatic vein waveform, and portal vein pulsatility, was assessed. Patients with grade 0 and I were allowed to receive boluses of IV fluid on admission, according to the decision of the treating intensivist. Patients with grades II and III were observed only with fluid restriction and diuresis until renal replacement therapy if needed.

Results: Of the 109 patients with suspected sepsis, 33 (30%) with renal and cardiac failure were selected. The median patient age was 73 (57-85) years, and 15 (45.5%) patients were men.

The mean left ventricular ejection fraction was 46%, the tissue Doppler right ventricle S’ was 8.8 cm, the right ventricular diameter was 3.9 cm, the mean pulmonary hypertension was 51 mmHg, and the mean creatinine was 377 µmol/l. There were 17 (51.5%) patients with acute kidney injury. Seventeen patients (51.5%) had VExUS grade III. The resolution of AKI was significantly correlated with improvement in VExUS grade (p-value 0.005). Renal replacement therapy was needed acutely for seven (24%) VExUS grade III patients. There was a significant association between changes in VExUS grade and fluid balance (p-value 0.006).

Conclusion: In populations with sepsis and cardiorenal disease, the combined grading of IVC, hepatic vein, and portal vein (VExUS) can aid in managing fluid and predict the need for renal replacement therapy.

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