Gupta Bhavna, Ahluwalia Pallavi, Gupta Anish, Ranjan Nikhil, Kakkar Kamna, Aneja Parag
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Anaesthesiology, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh, India.
Indian J Anaesth. 2023 Nov;67(Suppl 4):S218-S226. doi: 10.4103/ija.ija_475_23. Epub 2023 Nov 21.
The venous excess ultrasound (VExUS) score presents a prospect of valuable clinical utility. The study aimed to systematically review the effectiveness of the VExUS score in detecting venous congestion across emergency, critical care, and peri-operative contexts; assessing its utility in improved patient outcomes; and exploring its relationship with established parameters.
This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42023421034). A comprehensive literature search, employing pre-defined search terms related to the VExUS score in diverse clinical contexts, was conducted on articles published between 2000 and 15 May 2023 across databases- PubMed, PubMed Central, Cochrane, Scopus, Elsevier Clinical Key, and Google Scholar. Bias risk assessment was carried out using the Risk of Bias in Non-Randomised Studies tool. Given the significant heterogeneity across studies concerning participants, interventions, outcomes, and study designs, data pooling for a meaningful meta-analysis was not feasible.
The review included 15 articles comprising observational studies, case series, and case reports. Most patients exhibited moderate-to-severe venous congestion based on their baseline VExUS scores. Higher VExUS scores correlated with a greater risk of acute kidney injury (AKI) in post-operative patients. The VExUS score strongly correlated with central venous pressure; specific components, such as the intra-renal monophasic pattern, portal-pulsatility, and inferior vena cava diameter, exhibited robust predictive value for venous congestion.
VExUS score is valuable in assessing and predicting venous congestion, especially regarding AKI prediction risk and guiding interventions. However, its utility in predicting outcomes in acute heart failure patients appears less certain.
静脉超声评分（VExUS）具有重要的临床应用前景。本研究旨在系统评价VExUS评分在急诊、重症监护及围手术期检测静脉淤血的有效性；评估其对改善患者预后的作用；并探讨其与既定参数的关系。
本系统评价已在国际前瞻性系统评价注册库（CRD42023421034）注册。采用与不同临床背景下VExUS评分相关的预定义检索词，对2000年至2023年5月15日期间发表在PubMed、PubMed Central、Cochrane、Scopus、爱思唯尔临床关键数据库和谷歌学术等数据库中的文章进行全面文献检索。使用非随机研究中的偏倚风险工具进行偏倚风险评估。鉴于研究在参与者、干预措施、结局和研究设计方面存在显著异质性，进行有意义的荟萃分析的数据合并不可行。
该评价纳入了15篇文章，包括观察性研究、病例系列和病例报告。根据基线VExUS评分，大多数患者表现为中度至重度静脉淤血。术后患者中，较高的VExUS评分与急性肾损伤（AKI）风险增加相关。VExUS评分与中心静脉压密切相关；肾内单相模式、门静脉搏动性和下腔静脉直径等特定成分对静脉淤血具有较强的预测价值。
VExUS评分在评估和预测静脉淤血方面具有重要价值，尤其是在预测AKI风险和指导干预措施方面。然而，其在预测急性心力衰竭患者结局方面的作用似乎不太确定。
