VExUS Point-of-Care Ultrasound Tool to Detect Changes in Volume Status: A Prospective Observational Study

Venous excess ultrasound score (VExUS) is an emerging point-of-care ultrasound tool to evaluate venous congestion using inferior vena cava (IVC) diameter and hepatic vein pulse-wave Doppler. The utility of VExUS to detect changes in intravascular volume is not well established.

The objective of the study was to investigate the ability of a standardized point-of-care ultrasound exam to capture dynamic changes in volume status.

This was a prospective observational study of inpatients with end-stage renal disease. Patients underwent VExUS exams before and after hemodialysis (HD). Patient with an IVC diameter <2 cm had a VExUS score of 0. For patients with an IVC diameter >2 cm, the scores of the component were totaled for a composite score. The primary outcome was change in composite VExUS score. A univariate linear regression analysis was used to evaluate for a linear relationship between the volume of fluid removed and change in composite VExUS score.

Forty-six patients (92 paired ultrasound exams) were included. The median volume of fluid removed with HD was 2,000 mL (IQR: 985-2,500 mL). Wilcoxon signed-rank test of pre-HD and post-HD VExUS scores revealed a median score decrease of 1.5 (95% CI: 1-2; P < 0.001) on a VExUS scale ranging from 0 to 4. There was not a significant linear relationship between volume removed and change in VExUS score.

Fluid removal with HD was associated with changes in the VExUS score, highlighting the utility of VExUS to capture dynamic shifts in intravascular volume in patients with end-stage renal disease.