- Design
- Systematic review and meta-analysis of 32 studies
- Population
- 3,142 cardiac and critically ill patients
- Primary outcome
- Diagnostic accuracy for raised venous pressure; AKI and mortality
- Effect
- Cardiac: AKI OR 4.44 (2.34–8.43); ICU: AKI OR 1.45 (0.70–2.99)
A systematic review and meta-analysis in Critical Care Medicine (published 9 June) gathered 32 studies with 3,142 patients on the venous excess ultrasound (VExUS) score, which grades congestion from the IVC and hepatic, portal and intrarenal venous Doppler.
Diagnostic studies, too varied to pool, suggested sensitivity of 78–95% and specificity of 80–90% for raised central venous or right atrial pressure. In cardiac patients, a grade of 2 or more was associated with acute kidney injury (OR 4.44, 95% CI 2.34–8.43, moderate certainty) and death (OR 3.17, 1.30–7.75, low certainty). In general critically ill patients there was no clear association with AKI (OR 1.45, 0.70–2.99) or death (OR 1.25, 0.77–2.03).
VExUS is a useful bedside signal that the venous side is congested — a reason to stop giving fluid and consider decongestion. It is not yet a validated prognostic tool for the mixed ICU population, and treating to a VExUS grade has not been tested in trials.
- Use VExUS to add venous information to the fluid decision, not to replace clinical assessment
- A grade of 2 or 3 is a reason to pause further fluid
- Interpret portal pulsatility with caution in cirrhosis and in thin patients
- Repeat after decongestion to see whether the grade falls
Why it matters
It sets limits on a tool many emergency physicians and intensivists have adopted quickly.
Don't overread it
No trial has shown that managing to a VExUS grade improves outcomes.
The statistics, in plain English
An odds ratio of 4.44 in cardiac patients is a strong association, with an interval well above 1. In general critically ill patients the intervals cross 1, so no association was shown. Certainty was mostly low because studies were small and varied.
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