Fluid Status Assessment and the Role of the Venous Excess Ultrasound (VExUS) Score

Interventional radiologists frequently assume care of patients with high severity of acute and chronic illnesses, many of which can contribute to shock and organ failure in the inpatient setting. The ability to quickly assess the hemodynamic status of a decompensating patient at bedside is therefore a valuable skill for IRs to develop. Assessment of intravascular volume status is fundamental to this-shock and organ failure are commonly precipitated by hypovolemia resulting in decreased circulating blood volume and organ perfusion, but may also develop due to fluid overload resulting in heart failure and organ malperfusion due to venous congestion. The venous excess ultrasound (VExUS) protocol is a rapid point-of-care sonographic exam that scores severity of systemic venous congestion by integrating analysis of multiple venous beds. Here, we review traditional methods of estimating intravascular volume status, technical aspects of the VExUS examination, interpretation of VExUS results, and practical applications for VExUS.