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Venous Congestion Assessed by Venous Excess Ultrasound (VExUS) and Acute Kidney Injury in Children with Right
Rajeswari Natraj1, Anu Kirthiga Bhaskaran2, Philippe Rola3
1Pediatric Intensive Care Unit and Cardiothoracic Services, Apollo Children's Hospital, Chennai, Tamil Nadu, India.
Insights
Venous Excess Ultrasound (VExUS) can identify venous congestion in children with right ventricular dysfunction after heart surgery. Elevated VExUS scores are linked to acute kidney injury, highlighting VExUS as a key diagnostic tool.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Nephrology
Background:
- Right ventricular dysfunction (RVD) is a significant complication in children post-congenital cardiac surgery.
- RVD can lead to systemic venous congestion, impacting organ function, including the kidneys.
- Assessing venous congestion is crucial for managing RVD complications.
Purpose of the Study:
- To determine the association between venous congestion, measured by Venous Excess Ultrasound (VExUS), and acute kidney injury (AKI) in pediatric patients with RVD.
- To evaluate changes in VExUS scores following treatment for RVD and venous congestion.
- To explore VExUS as a bedside tool for assessing venous congestion.
Main Methods:
- Prospective observational study involving pediatric patients with RVD.
- Venous Excess Ultrasound (VExUS) assessments performed on days 1, 2, and 3 post-surgery.
- Correlation analysis between VExUS scores, central venous pressure (CVP), and occurrence of AKI.
Main Results:
- A significant association was found between severe RVD, elevated pulmonary artery systolic pressures, and VExUS scores >2.
- Elevated VExUS scores demonstrated a significant association with central venous pressure (CVP) measurements.
- Among patients with VExUS scores >2, 58% developed AKI, and improving CVP and fluid balance correlated with decreasing VExUS scores.
Conclusions:
- Venous Excess Ultrasound (VExUS) is a valuable bedside tool for diagnosing and grading venous congestion.
- Elevated VExUS scores are associated with the development of AKI in children with RVD.
- Portal vein pulsatility, a component of VExUS, may serve as a predictor for AKI.
Background:
Right ventricular dysfunction (RVD) is a complication following congenital cardiac surgery in children and can lead to systemic venous congestion, low cardiac output, and organ dysfunction. Venous congestion can be transmitted backwards and adversely affect encapsulated organs such as the kidneys.
Primary Objective:
To investigate the association between systemic venous congestion, as estimated by Venous Excess Ultrasound (VExUS), and the occurrence of acute kidney injury (AKI) in children with RVD following congenital heart surgery. Secondary objectives included comparing changes in VExUS scores after initiating treatment for RVD and venous congestion.
Methods And Results:
This was a prospective observational study in children with RVD. The VExUS study was performed on day 1, day 2, and day 3 and categorized as VExUS-1, VExUS-2, and VExUS-3. Among 43 patients with RVD and dilated inferior vena cava, 19/43 (44%), 10/43 (23%), and 12/43 (28%) were VExUS-2 and VExUS-3, respectively. There was an association between severe RVD and elevated pulmonary artery systolic pressures and a VExUS score >2. A significant association was observed between central venous pressure (CVP) measurements and VExUS. Among 31 patients with a high VExUS score >2, 18 (58%) had AKI. Additionally, improvement in CVP and fluid balance was associated with improving VExUS scores following targeted treatment for RVD.
Conclusion:
VExUS serves as a valuable bedside tool for diagnosing and grading venous congestion through ultrasound Doppler. An elevated VExUS score was associated with the occurrence of AKI, and among the components of VExUS, portal vein pulsatility may be useful as a predictor of AKI.
How To Cite This Article:
Natraj R, Bhaskaran AK, Rola P, Haycock K, Siuba MTT, Ranjit S. Venous Congestion Assessed by Venous Excess Ultrasound (VExUS) and Acute Kidney Injury in Children with Right Ventricular Dysfunction. Indian J Crit Care Med 2024;28(5):447-452.
