Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Department of Anesthesiology and Intensive Care, Montreal Heart Institute, Montréal, Canada.
Ultrasound Med Biol. 2023 Jan;49(1):3-17. doi: 10.1016/j.ultrasmedbio.2022.07.011. Epub 2022 Oct 4.
Organ congestion from venous hypertension is an important pathophysiological mechanism mediating organ injury in several clinical contexts including critical illness, congestive heart failure and end-stage chronic kidney disease. However, the practical evaluation of venous congestion is often challenging at the bedside because of the limitations of traditional methods. Point-of-care ultrasound (POCUS) enables the clinician to assess venous velocity profiles during the cardiac cycle using Doppler modalities. Venous Doppler profile abnormalities at multiple sites are detected when elevated venous pressure results in hemodynamic changes within the systemic venous circulation. The detection of these abnormal Doppler profiles may identify patients with clinically significant systemic venous congestion. These patients have been reported to be at increased risk of medical complications. Improving the evaluation of venous congestion may lead to individualized treatment and improved patient outcomes. In this review, we describe the physiologic principles necessary to understand venous Doppler assessment. We also propose a nomenclature for the description of venous Doppler profiles. Finally, we provide a narrative review of the current clinical evidence related to use of venous Doppler assessment in various clinical contexts.
静脉高压引起的器官充血是几种临床情况下介导器官损伤的重要病理生理机制，包括危重病、充血性心力衰竭和终末期慢性肾脏病。然而，由于传统方法的局限性，静脉充血的实际评估在床边往往具有挑战性。床边即时超声（POCUS）使临床医生能够使用多普勒模式在心脏周期期间评估静脉速度谱。当升高的静脉压导致全身静脉循环中的血液动力学变化时，会在多个部位检测到静脉多普勒轮廓异常。当检测到这些异常的多普勒轮廓时，可能会识别出具有临床显著全身静脉充血的患者。据报道，这些患者有更高的医疗并发症风险。改善静脉充血的评估可能会导致个体化治疗和改善患者预后。在这篇综述中，我们描述了理解静脉多普勒评估所需的生理原理。我们还提出了一种用于描述静脉多普勒轮廓的命名法。最后，我们对静脉多普勒评估在各种临床情况下的临床证据进行了叙述性综述。
