[Role of ultrasound in critically ill patients with heart failure]

Heart failure (HF) is a clinical syndrome with symptoms and/or signs caused by structural and/or functional cardiac abnormalities. After discharge, patients with acute heart failure (AHF) face a significant risk of rehospitalization and mortality. Detection of residual congestion is crucial to reduce readmissions, improve prognosis, and decrease mortality. Echocardiography provides critical information about the severity of left ventricular dysfunction, elevated filling pressures, valvular dysfunction, and estimation of pulmonary artery systolic pressure. The VExUS approach integrates ultrasound evaluation of the inferior vena cava, hepatic veins, portal vein, and renal veins, providing valuable information about systemic congestion. Lung ultrasound detects pulmonary congestion, facilitating early intervention to prevent progression and hospitalizations. Ultrasound evaluation of the internal jugular vein and femoral vein complements the evaluation of venous congestion. Distension of the internal jugular vein during the Valsalva maneuver or the relationship between the diameter of the internal jugular vein and the femoral vein can predict adverse outcomes in patients with HF. In conclusion, a comprehensive ultrasound approach is crucial in the management of patients with critically ill heart failure. Multiparameter ultrasound evaluation provides vital information, guiding appropriate therapeutic interventions and avoiding potentially harmful measures.