VExUS: common misconceptions, clinical use and future directions.

Area of Science:

• Critical Care Medicine
• Cardiovascular Physiology
• Point-of-Care Ultrasound

Background:

• Venous congestion is a growing clinical concern, with the Venous Excess Ultrasound (VExUS) score gaining prominence.
• Current clinical and research efforts show persistent misconceptions regarding the VExUS score's interpretation.
• These misconceptions include attempts to directly correlate VExUS with volume status and re-interpret it within specific pathologies.

Purpose of the Study:

• To clarify the physiological underpinnings of the VExUS score.
• To address common misunderstandings among clinicians and researchers regarding VExUS interpretation.
• To highlight the VExUS score's role in the context of fluid tolerance.

Main Methods:

• Review of the physiological principles governing venous congestion.
• Analysis of the VExUS score's application as a marker of organ-specific venous pressure.
• Exploration of the relationship between venous congestion and fluid tolerance.

Main Results:

• The VExUS score reflects organ-level venous congestion, influenced by but not solely determined by volume status.
• Misinterpretations arise from viewing VExUS as a direct volume assessment tool.
• VExUS provides a unique circulatory perspective crucial for understanding fluid tolerance.

Conclusions:

• The VExUS score is a physiological measure of venous congestion, not a direct indicator of volume status.
• A correct understanding of VExUS physiology is essential for accurate clinical application and research.
• The VExUS score is integral to the emerging concept of fluid tolerance, offering insights into organ perfusion.