Portable handheld ultrasound for VExUS assessment in critical care: Reliability and time efficiency in resident-led...

Pathologic venous congestion significantly impacts outcomes yet remains underrecognized, necessitating practical bedside assessment. We evaluated the reliability and reproducibility of the venous excess ultrasound (VExUS) score using handheld ultrasound among resident trainees managing critically ill patients.

Two blinded residents, trained in a short VExUS course, independently performed sequential VExUS scans on 80 critically ill patients using both handheld ultrasound and conventional ultrasound. Two ICU mentors then interpreted the anonymized images to establish gold-standard VExUS scores and assess image quality. We evaluated inter-rater reliability (IRR) and inter-user reproducibility (IUR) using Cohen's κ and intraclass correlation coefficient (ICC) for categorical outcomes. For continuous data, we used Spearman correlation, ICC, Deming regression, and Bland-Altman analysis. We also recorded the procedural time for each scan.

In 80 ICU patients, handheld and conventional ultrasound showed strong agreement for most VExUS parameters (Bland-Altman/Deming), with IVC diameter demonstrating minimal bias (0.037 cm; rho = 0.92, ICC = 0.98) and hepatic velocities negligible differences (ICC > 0.96). Both devices achieved high inter-rater VExUS grading reliability (handheld κ = 0.879/ICC = 0.912; conventional κ = 0.851/ICC = 0.865), though handheld showed reduced renal vein concordance (κ = 0.55 vs conventional 0.653). Image acquisition succeeded in >91 % cases (hepatic/IVC 100 %). Handheld ultrasound halved procedural time (5 vs 8 min, p < 0.0001) with comparable grading accuracy (p = 0.747).

Handheld ultrasound provides reliable VExUS assessment comparable to conventional systems (VExUS grade κ > 0.85), with 40 % faster procedural time (5 vs 8 min, p < 0.0001). Despite renal vein evaluation challenges (handheld κ = 0.55), high image acquisition (>91 %) and inter-rater agreement support its utility for venous congestion monitoring in critical care.