It was great to e-meet a multi-disciplinary group of docs interested in POCUS yesterday, as I was invited by my friends Michael Woo and Ross Prager to talk about VExUS and venous congestion!
Great and very pertinent questions by the Ottawa group, so I’m hoping to see the use of venous doppler take off in their units!
Here is the talk:
love to hear your thoughts!
Dr Rola, myname is Pedro Alvarado,i´m a mexican critical care fellow (currently in the 2/2 training year). Been very intrested in the last year on being able to answere the quiestion: is my patient going to benefit form fluid administration? (particularly in the case of an objectively diagnosed distributive shock + ARDS, i think by the way, a very difficult to answer question in the mayority of mexican ICU´s). To answer this question i thought, until lastly, one should start by answering if the patient is fluid responsiveness. The concept of venous congestion and fluid tolerance seems to be the counterbalance that might complete the equaition of benefit/harm raitio of fluid administration on an already high-output state. As it is, i´ve been very intrested on what you have recently been describing as the VexUs score. One quiestion Dr… you mention this US tool as a usefull stop point for fluid adminiatration in septic (distributive I assume) patients. I understand from your explanation that the furhter you document ultrasonographic sings of venous hypertension from the RA (hepatic -portal-renal vein), the worse the hypertension and possibly its consequences might be. Also you imply that the earliest you document signs of venous hypertension, the better, so that you can counterbalance benefit/ham ratio of fluid administration as soon as posible. Understanding that the first, relatevily easy measurble macrostucrure to be affected by right-sided hypertension is the RA, what makes VExUS more valuable than a good, old CVP monitorization for this purpose? Far more expensive and time consuming, the US is. Also CVP abosulte values and trends can be continously measured.
making a post of it!