Introduction: Fluid overload and venous congestion are deleterious in critically ill patients with cardiorenal syndrome. There is scarce literature on Venous excess ultrasound score (VEXUS) assessment characteristics in cardiorenal syndromes with hypoxic respiratory failure and sepsis.
Methods: This study was an observational, prospective, single-center study, including the patients with sepsis and heart failure who were transferred to the cardiac care unit (CCU). VEXUS comprising inferior vena cava, hepatic vein waveform, and portal vein pulsatility was assessed. The patient with grade 0 and I was allowed to receive boluses of IV fluid on admission. Grades 2 and 3 were observed only with fluid restriction and diuresis till renal replacement therapy if needed. staging of venous congestion VEXUS Grade 0: IVC grade < III, HD grade 0, PV grade 0 Grade I: IVC grade IV, but normal HV/PV pattern Grade II: IVC grade IV with mild flow pattern abnormalities in HV/PV Grade III: IVC grade IV with severe flow pattern abnormalities in HV/PV
Results: Of the 109 patients with suspected sepsis, 33(71%) were selected with renal and cardiac failure. The median patient age was 73 (57–85) years, and 15 (45.5%) were men. The clinical characteristics of the patients with confirmed cardiorenal syndrome are shown in Table 1. The mean Left ventricular ejection fraction was 46%, the tissue Doppler right ventricle was S’8.8 cm, the mean pulmonary hypertension was 51 mmHg, and the mean creatinine was 377ummol/l. Patients with acute kidney injury were 17 (82%). Seventeen patients (51.5%) had VEXUS grade III. The Resolution of AKI injury significantly correlated with improvement in VEXUS grade (p-value 0.005). Renal replacement therapy was needed acutely for VEXUS grade III in six patients (18%) and two in VEXUS grade 2 (6%); no renal replacement therapy was conducted in grades 0 and 1. Grade 0, and I received fluid for resolution of acute kidney injury. There was a significant association between changes in VEXUS grade and fluid balance (p-value 0.04).
Conclusions: In a population with sepsis and cardiorenal disease, the combined grading of IVC, hepatic vein, and portal vein (VEXUS) can help manage fluid and predict the need for renal replacement therapy.
