Department of Internal Medicine, University of Colorado Hospital, Aurora, CO, USA.
School of Medicine, University of Colorado, University of Colorado, Aurora, CO, USA.
Crit Care. 2023 May 26;27(1):205. doi: 10.1186/s13054-023-04471-0.
Venous congestion is an under-recognized contributor to mortality in critically ill patients. Unfortunately, venous congestion is difficult to measure, and right heart catheterization (RHC) has been considered the most readily available means for measuring venous filling pressure. Recently, a novel "Venous Excess Ultrasound (VExUS)" score was developed to noninvasively quantify venous congestion using inferior vena cava (IVC) diameter and Doppler flow through the hepatic, portal, and renal veins. A preliminary retrospective study of post-cardiac surgery patients showed promising results, including a high positive-likelihood ratio of high VExUS grade for acute kidney injury. However, studies have not been reported in broader patient populations, and the relationship between VExUS and conventional measures of venous congestion is unknown. To address these gaps, we prospectively assessed the correlation of VExUS with right atrial pressure (RAP), with comparison to inferior vena cava (IVC) diameter. Patients undergoing RHC at Denver Health Medical Center underwent VExUS examination before their procedure. VExUS grades were assigned before RHC, blinding ultrasonographers to RHC outcomes. After controlling for age, sex, and common comorbidities, we observed a significant positive association between RAP and VExUS grade (P < 0.001, R = .68). VExUS had a favorable AUC for prediction of a RAP ≥ 12 mmHg (0.99, 95% CI 0.96-1) compared to IVC diameter (0.79, 95% CI 0.65-0.92). These results suggest a strong correlation between VExUS and RAP in a diverse patient population, and support future studies of VExUS as a tool to assess venous congestion and guide management in a spectrum of critical illnesses.
静脉淤血是危重病患者死亡的一个未被充分认识的原因。不幸的是，静脉淤血难以测量，而右心导管检查（RHC）一直被认为是测量静脉充盈压最容易获得的手段。最近，一种新的“静脉过度超声（VExUS）”评分系统被开发出来，用于通过下腔静脉（IVC）直径和肝静脉、门静脉和肾静脉的多普勒血流来无创量化静脉淤血。一项对心脏手术后患者的初步回顾性研究显示了有前景的结果，包括高 VExUS 分级对急性肾损伤的高阳性似然比。然而，这些研究尚未在更广泛的患者人群中报告，并且 VExUS 与静脉淤血的常规测量之间的关系尚不清楚。为了解决这些差距，我们前瞻性评估了 VExUS 与右心房压（RAP）的相关性，并与下腔静脉（IVC）直径进行了比较。在丹佛健康医疗中心接受 RHC 的患者在其手术前接受了 VExUS 检查。在进行 RHC 之前，VExUS 分级被分配，超声医师对 RHC 结果进行了盲法评估。在控制年龄、性别和常见合并症后，我们观察到 RAP 与 VExUS 分级之间存在显著的正相关（P < 0.001，R = 0.68）。VExUS 对预测 RAP ≥ 12mmHg 的 AUC 有利（0.99，95%CI 0.96-1），优于 IVC 直径（0.79，95%CI 0.65-0.92）。这些结果表明，在多样化的患者人群中，VExUS 与 RAP 之间存在很强的相关性，并支持未来对 VExUS 作为评估静脉淤血和指导一系列危重病管理的工具进行研究。
