Khan AA, Saeed H, Haque IU, Iqbal A, Du D, Koratala A. Point-of-care ultrasonography spotlight: Could venous excess ultrasound serve as a shared language for internists and intensivists? World J Crit Care Med 2024; 13(2): 93206 [PMID: 38855280 DOI: 10.5492/wjccm.v13.i2.93206]
Corresponding Author of This Article
Abhilash Koratala, MD, FASN, Associate Professor, Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI 53226, United States. akoratala@mcw.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jun 9, 2024; 13(2): 93206 Published online Jun 9, 2024. doi: 10.5492/wjccm.v13.i2.93206
Point-of-care ultrasonography spotlight: Could venous excess ultrasound serve as a shared language for internists and intensivists?
Anosh Aslam Khan, Hasham Saeed, Ibtehaj Ul Haque, Ayman Iqbal, Doantrang Du, Abhilash Koratala
Anosh Aslam Khan, Doantrang Du, Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740, United States
Hasham Saeed, Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ 07202, United States
Ibtehaj Ul Haque, Department of Anesthesiology, Dr. Ruth K M Pfau Civil Hospital, Karachi 74400, Pakistan
Ayman Iqbal, Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
Abhilash Koratala, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Author contributions: Khan AA, Saeed H, Haque IU, Iqbal A, Du D prepared the initial draft; Koratala A reviewed the manuscript for critical intellectual content and revised accordingly.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abhilash Koratala, MD, FASN, Associate Professor, Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI 53226, United States. akoratala@mcw.edu
Received: February 21, 2024 Revised: April 24, 2024 Accepted: May 11, 2024 Published online: June 9, 2024 Processing time: 102 Days and 15.3 Hours
Abstract
Point-of-care ultrasonography (POCUS), particularly venous excess ultrasound (VExUS) is emerging as a valuable bedside tool to gain real-time hemodynamic insights. This modality, derived from hepatic vein, portal vein, and intrarenal vessel Doppler patterns, offers a scoring system for dynamic venous congestion assessment. Such an assessment can be crucial in effective management of patients with heart failure exacerbation. It facilitates diagnosis, quantification of congestion, prognostication, and monitoring the efficacy of decongestive therapy. As such, it can effectively help to manage cardiorenal syndromes in various clinical settings. Extended or eVExUS explores additional veins, potentially broadening its applications. While VExUS demonstrates promising outcomes, challenges persist, particularly in cases involving renal and liver parenchymal disease, arrhythmias, and situations of pressure and volume overload overlap. Proficiency in utilizing spectral Doppler is pivotal for clinicians to effectively employ this tool. Hence, the integration of POCUS, especially advanced applications like VExUS, into routine clinical practice necessitates enhanced training across medical specialties.
Core Tip: Point-of-care ultrasonography (POCUS) plays a crucial role in assessing fluid overload in heart failure patients. This review explores the utility of venous excess Doppler ultrasound, emphasizing POCUS's value in real-time hemodynamic evaluation for personalized decongestive management.
