VExUS
Venous Excess Ultrasound is a grading system of systemic venous congestion. It is useful in the emergency department for patients whose fluid status is uncertain and can guide fluid resuscitation and potentially avoid systemic congestion. It is potentially useful in patients with septic shock, right heart failure or renal failure and it can be a predictor of mortality.
Classically we have used the inferior vena cava(IVC) to measure central venous pressure (CVP), given that it dilates with an increase in CVP. However it is only useful to a point, after which maximal dilatation occurs and there is retrograde pressure increase in the venous system affecting the liver and kidneys. IVC dilatation may also be falsely positive in conditions such as pulmonary hypertension.
The VExUS protocol assists in assessing the IVC and then looks at potential congestion in the hepatic, portal and renal systems.
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