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World J Crit Care Med. Sep 9, 2026; 15(3): 122632
Published online Sep 9, 2026. doi: 10.5492/wjccm.122632
Published online Sep 9, 2026. doi: 10.5492/wjccm.122632
Venous dimension of shock: Integrating arterial inflow and venous back-pressure in hemodynamic assessment
Sahil Kataria, Department of Critical Care Medicine, Holy Family Hospital, New Delhi 110025, Delhi, India
Saketh Vinjamuri, Department of General Medicine, Gandhi Medical College, Hyderabad 500003, Telangāna, India
Deven Juneja, Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, Delhi, India
Sargam Goel, Department of Anaesthesiology, ESI Hospital, Okhla, New Delhi 110020, Delhi, India
Co-corresponding authors: Sahil Kataria and Deven Juneja.
Author contributions: Kataria S conceived and conceptualized the study, performed the primary literature review, drafted the manuscript, prepared all images; Vinjamuri S and Goel S contributed to literature review and manuscript refinement; Juneja D contributed to conceptualization, critical intellectual input, substantial manuscript revision, and overall supervision of the work; and all authors approved the final manuscript. Kataria S conceived and conceptualized the study, conducted the primary literature review, drafted the manuscript, and prepared all images. Juneja D contributed to conceptualization, critical intellectual input, substantial manuscript revision, and overall supervision of the work. Both Kataria S and Juneja D have played crucial and indispensable roles in conceptualizing the manuscript, literature synthesis and interpretation, and manuscript preparation. They have made vital contributions towards the completion of the project and thus qualify as the co-corresponding authors.
AI contribution statement: The authors used Grammarly AI tool for language polishing, grammar correction, and improvement of readability during manuscript preparation.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Deven Juneja, MD, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1 Press Enclave Road, New Delhi 110017, Delhi, India.
Received: April 24, 2026
Revised: June 12, 2026
Accepted: June 25, 2026
Published online: September 9, 2026
Processing time: 120 Days and 6.5 Hours
Revised: June 12, 2026
Accepted: June 25, 2026
Published online: September 9, 2026
Processing time: 120 Days and 6.5 Hours
Core Tip
Core Tip: Venous congestion is an underrecognized cause of organ hypoperfusion in critical illness. This review highlights how elevated venous pressure can reduce organ perfusion despite apparently preserved arterial hemodynamics. The arterial-venous perfusion gradient is presented as a pragmatic clinical synthesis of established physiology, providing a bedside framework to interpret arterial inflow, venous outflow, and tissue perfusion together during shock assessment and resuscitation.