Thread by @PulmCrit

VEXUS score to assess systemic congestion via ultrasonography. Systemic venous congestion is dangerous for multiple reasons, so early identification and management may be important.
- @WBeaubien at #HRreloaded

1st component of VEXUS = venous return via the hepatic veins.
- @WBeaubien at #HRreloaded

interpretation of hepatic vein doppler waveform:
normal: systolic equal or greater than diastolic
mild: systolic smaller
severe: systolic reversal
- @WBeaubien at #HRreloaded

2nd component of VEXUS interrogates compliance of the venous system. Normally portal vein flow isn't pulsatile, but if the veins are distended and noncompliant then venous pulsations extend *backwards* from the IVC into the portal vein.
- @WBeaubien at #HRreloaded

Intra-renal doppler is the last component of the VEXUS score.
- @WBeaubien at #HRreloaded

Any single component of US assessment of congestion may fail. therefore, it's best to integrate multiple features together in the VEXUS score
- @WBeaubien at #HRreloaded

Different components of VEXUS predict kidney injury s/p surgery. This suggests that a considerable amount of post-operative AKI is due to congestion! VEXUS score with multiple features integrated *together* was better than any single component.
- @WBeaubien at #HRreloaded

VEXUS grade three requires at least 2 of 3 signs of systemic congestion
- @WBeaubien at #HRreloaded

VEXUS can be improved by fluid removal (diuresis/dialysis) or pulmonary vasodlators. Thus, VEXUS may be used to titrate fluid removal and hemodynamic manipulations.
- @WBeaubien at #HRreloaded