Point-of-care Ultrasound after Cardiac Surgery: Understanding the Congestion Cascade

Point-of-care ultrasound (POCUS) is an essential tool in perioperative and cardiac critical care, providing rapid, bedside evaluation of cardiac function, pulmonary pathology, and volume status. This article introduces a protocolized, whole-body POCUS approach centered on the sonographic congestion cascade, conceptualizing the cardiopulmonary venous system as a continuous physiologic unit. By integrating cardiac, lung, and multisite venous Doppler findings, clinicians can identify shock etiologies, characterize congestion phenotypes, and guide individualized, physiology-driven management in patients with undifferentiated shock and respiratory failure.