Kanitkar Shubhangi, Soni Kritika, Vaishnav Bhumika
Internal Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND.
Cureus. 2024 Aug 2;16(8):e66003. doi: 10.7759/cureus.66003. eCollection 2024 Aug.
The introduction of point-of-care ultrasound (POCUS) into clinical practice has revolutionized bedside hemodynamic assessment in recent years. POCUS has expanded its utility to include evaluating and grading venous congestion through Doppler analysis of venous blood flow. This innovative technique, VExUS (venous excess ultrasound), comprehensively evaluates venous congestion across multiple sites, including the inferior vena cava (IVC), hepatic vein, portal vein, and intrarenal vasculature. The aim of the current study was to determine whether venous excess ultrasound can help guide fluid therapy in complex patients with acute kidney injury (AKI) in addition to the standard physical examination and imaging.
Our current study shows instructive 18 clinical adult cases (enrolled between January 2024 and May 2024) to determine whether venous excess ultrasound can help guide fluid therapy in complex cardiac patients with acute kidney injury, in addition to the standard physical examination and imaging.
VExUS was pivotal in guiding fluid therapy in all complex patients with AKI and suspected right ventricular dysfunction. By integrating VExUS findings with clinical data and cardiac ultrasound results, clinicians were able to make patient-favouring decisions regarding fluid management, diuresis, and vasopressor therapy, addressing critical aspects of conditions such as septic shock, heart failure, and acute kidney injury.
In our study of VExUS in sick patients with AKI, we concluded that VExUS proved to be a valuable tool for fluid assessment and management. By providing real-time visualization of venous congestion, VExUS allowed for more precise and individualized fluid management strategies. This led to improved decision-making regarding fluid administration and removal, helping to prevent both fluid overload and hypovolemia. Consequently, the use of VExUS contributed to better clinical outcomes in patients with AKI, demonstrating its potential as a critical component in the management of fluid balance in this vulnerable patient population.
近年来，即时超声检查（POCUS）引入临床实践，彻底改变了床边血流动力学评估。POCUS的应用范围已扩大，包括通过对静脉血流进行多普勒分析来评估和分级静脉充血情况。这种创新技术，即静脉充血超声检查（VExUS），可全面评估多个部位的静脉充血情况，包括下腔静脉（IVC）、肝静脉、门静脉和肾内血管系统。本研究的目的是确定除了标准体格检查和影像学检查外，静脉充血超声检查是否有助于指导急性肾损伤（AKI）复杂患者的液体治疗。
我们目前的研究展示了18例有指导意义的成年临床病例（于2024年1月至2024年5月入组），以确定除了标准体格检查和影像学检查外，静脉充血超声检查是否有助于指导急性肾损伤复杂心脏病患者的液体治疗。
VExUS在指导所有急性肾损伤复杂患者及疑似右心室功能障碍患者的液体治疗中起关键作用。通过将VExUS检查结果与临床数据及心脏超声结果相结合，临床医生能够就液体管理、利尿和血管加压药治疗做出有利于患者的决策，解决脓毒性休克、心力衰竭和急性肾损伤等病症的关键问题。
在我们对急性肾损伤患病患者进行的VExUS研究中，我们得出结论，VExUS被证明是一种用于液体评估和管理的有价值工具。通过实时显示静脉充血情况，VExUS实现了更精确和个性化的液体管理策略。这有助于在液体输注和清除方面做出更好的决策，有助于预防液体过载和血容量不足。因此，VExUS的应用改善了急性肾损伤患者的临床结局，证明了其作为这一脆弱患者群体液体平衡管理关键组成部分的潜力。
