Pediatric Intensive Care Department, La Paz University Hospital, Madrid, Spain.
J Ultrasound Med. 2023 Jan;42(1):211-220. doi: 10.1002/jum.16057. Epub 2022 Jul 10.
The Venous Excess Ultrasound (VExUS) score has been described as a useful tool to estimate the degree of venous congestion in adult patients. The present study aimed to analyze the feasibility and usefulness of the VExUS score to detect and grade central venous pressure (CVP) elevation in critically ill children.
A cross-sectional pilot study was conducted in a tertiary-care pediatric intensive care unit between November 2020 and June 2021. All children in whom CVP was monitored, were enrolled. At the time of central venous catheter placement, CVP and VExUS score grade were determined, analyzing the inferior vena cava (IVC) diameter and the hepatic (HVD), portal (PVD), and intrarenal (IRVD) venous Doppler waveforms.
A total of 33 children were studied (median age 12.2 [interquartile range (IQR) 4.1-100.6] months old; median weight 8.5 [IQR 5.6-35] kg; 20 [60.6%] males). The VExUS score was successfully obtained in 100% of the patients and its severity was strongly associated with the CVP levels (P < .001). Analyzing the VExUS score components separately, IVC dilation (P < .001) and severe HVD (P = .026), mild IRVD (P = .005), and severe IRVD (P = .025) patterns were associated with elevated CVP. After adjustment for confounding factors, IRVD pattern remained the only independent variable associated with elevated CVP.
The VExUS score appears to be a feasible and potentially useful bedside noninvasive monitoring tool for the detection and grading of CVP elevation in critically ill children. Among all its components, IRVD assessment seems most associated with high CVP in this population.
静脉过度超声（VExUS）评分已被描述为一种有用的工具，可用于评估成人患者静脉淤血的程度。本研究旨在分析 VExUS 评分在检测和分级危重症儿童中心静脉压（CVP）升高方面的可行性和实用性。
本研究为 2020 年 11 月至 2021 年 6 月在一家三级儿童重症监护病房进行的横断面试点研究。所有监测 CVP 的患儿均纳入本研究。在放置中心静脉导管时，测定 CVP 和 VExUS 评分等级，并分析下腔静脉（IVC）直径和肝静脉（HVD）、门静脉（PVD）和肾内静脉（IRVD）的多普勒血流波形。
共纳入 33 名患儿（中位年龄 12.2 [四分位距（IQR）4.1-100.6] 个月；中位体重 8.5 [IQR 5.6-35] kg；男 20 例[60.6%]）。100%的患儿成功获得了 VExUS 评分，其严重程度与 CVP 水平呈强相关（P<0.001）。单独分析 VExUS 评分成分，IVC 扩张（P<0.001）和重度 HVD（P=0.026）、轻度 IRVD（P=0.005）和重度 IRVD（P=0.025）与 CVP 升高相关。在调整混杂因素后，IRVD 模式仍然是与 CVP 升高相关的唯一独立变量。
VExUS 评分似乎是一种可行且具有潜在用途的床边非侵入性监测工具，可用于检测和分级危重症儿童的 CVP 升高。在所有成分中，IRVD 评估在该人群中与高 CVP 最相关。
