Key result
VExUS grade ≥2 is linked to higher LV E/A ratio and lower RV S wave.
Why the study?
VExUS has shown inconsistent associations with outcomes in general ICU patients, and the determinants of higher VExUS grades have not been studied in this population.
What factors are associated with higher VExUS (≥ 2) in a general ICU cohort?
Observational (n=145)
What factors are associated with higher VExUS (≥ 2) in a general ICU cohort?
Effect estimate: OR 0.85 and OR 2.34 (95% CI 0.74-0.97 and 1.27-4.33)
p-value: p=0.02 and 0.006
Higher VExUS grades in general ICU patients are primarily associated with ultrasound parameters of left- and right-sided cardiac systolic and/or diastolic function.
VExUS ≥2 links to biventricular function parameters in general ICU patients; hypothesis-generating and requires prospective validation before clinical adoption.
AIMS: Even though initially considered as a new standard in systemic venous congestion assessment, the semi-quantitative Doppler ultrasound-based venous excess ultrasound grading system (VExUS) showed inconsistent associations with outcomes in general intensive care unit (ICU) patients. It is unclear why VExUS is so effective in predicting outcomes in some cohorts and not in others. The determinants of higher VExUS have not been studied in a general ICU cohort. The aim of this study was to determine the factors associated with higher VExUS (≥ 2) in a general ICU cohort. METHODS AND RESULTS: We performed a post-hoc analysis of a prospective, observational cohort, including adult patients within 24 h of ICU admission and expected ICU length of stay longer than 2 days. Collected data included patients' haemodynamic status (including ultrasound evaluation) at several points in time: ICU admission, Day 1, Day 2, Day 5, and the last day of ICU stay. We analysed 514 haemodynamic evaluations in 145 patients. In total, 96/514 (18.7%) had a VExUS grade ≥ 2. The univariable followed by multivariable mixed-effects logistic regression analyses only found a statistically significant association between VExUS ≥ 2 and right ventricle S wave [OR 0.85 (0.74;0.97), P = 0.02] and left ventricle E/A ratio [OR 2.34, 95% CI (1.27;4.33), P = 0.006]. CONCLUSION: The current study has elucidated that higher VExUS is primarily associated with cardiac comorbidities and ultrasound parameters of left- and right-sided cardiac systolic and/or diastolic function in general ICU patients.
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Andrei et al. (2024) conducted an observational in Systemic venous congestion in general ICU patients (n=145). VExUS grading system was evaluated on Factors associated with VExUS grade ≥ 2 (specifically RV S wave and LV E/A ratio) (OR 0.85 and OR 2.34, 95% CI 0.74-0.97 and 1.27-4.33, p=0.02 and 0.006).
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