VExUS Point-of-Care Ultrasound Tool to Detect Changes in Volume Status

BACKGROUND: Venous excess ultrasound score (VExUS) is an emerging point-of-care ultrasound tool to evaluate venous congestion using inferior vena cava (IVC) diameter and hepatic vein pulse-wave Doppler. The utility of VExUS to detect changes in intravascular volume is not well established. OBJECTIVES: The objective of the study was to investigate the ability of a standardized point-of-care ultrasound exam to capture dynamic changes in volume status. METHODS: This was a prospective observational study of inpatients with end-stage renal disease. Patients underwent VExUS exams before and after hemodialysis (HD). Patient with an IVC diameter 2 cm, the scores of the component were totaled for a composite score. The primary outcome was change in composite VExUS score. A univariate linear regression analysis was used to evaluate for a linear relationship between the volume of fluid removed and change in composite VExUS score. RESULTS: Forty-six patients (92 paired ultrasound exams) were included. The median volume of fluid removed with HD was 2,000 mL (IQR: 985-2,500 mL). Wilcoxon signed-rank test of pre-HD and post-HD VExUS scores revealed a median score decrease of 1.5 (95% CI: 1-2; P < 0.001) on a VExUS scale ranging from 0 to 4. There was not a significant linear relationship between volume removed and change in VExUS score. CONCLUSIONS: Fluid removal with HD was associated with changes in the VExUS score, highlighting the utility of VExUS to capture dynamic shifts in intravascular volume in patients with end-stage renal disease.