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Today, we discuss the VEXUS Score. One of the big philosophical mistakes of early EMCrit was my approach to fluids in sepsis. It is no excuse that I was in good company--as in most of the intensivists in the US. I've come to my senses in the past 8 years or so and now I am actively fighting to avoid the drowning of our patients. One of the stalwarts in that fight is my buddy Phillipe Rola. He is an intensivist in Montreal, EMCrit team member, and creator of the Thinking Critical Care Blog.

He, along with Rory Spiegel and Korbin Haycock, has created the VEXUS score to evaluate your patient for fluid overload.

VEXUS Article

VEXUS Article

VEXUS Score

Hepatic Vein

Look at the IVC in the sub-xiphoid

Phased Array Probe may be easiest, but Curvilinear works as well

S wave should be larger than D wave

TR may be a confounder

S just after QRS if you have ECG leads

Portal Vein

Mid-Ax Line on Right Side with probe longitiduinal or R Costal Margin

Use curvilinear

Flow should move towards probe (red)

Normal is continuous flow

If it becomes pulsatile, there is backpressure

If it drops below baseline that is bad

PF <=0.5 (same thing as resistive index)

may be abnormal in pts with low BMI

Renal Artery

Curvilinear with Abd preset

Use color doppler to find vessels

Pick a vessel and look at the PW wave

RRI

0.55-0.7 is normal

Approaches 1 when there is an absence of diastolic flow

IRVF

Look for vein in parenchyma

 

from JACC HF 2016;4(8):683

 

Katie Wiskar Tutorial

Katie's Slide of Confounding Factors

Venous Excess Chapter from Phillipe's Book

venous-congestion-chapter

More from Phillipe on this Topic

* EMCrit Podcast 240- Renal Compartment Syndrome It's all about the Venous Side and We've Been Fracking it up for Years

* Posts on Thinking CC

* Vexus Lite

* VEXUS Mini-Tutorial with Live Vid of a Scan

Literature

* Tang Editorial JACCHF 2016

* VEXUS 2020

Resus Crisis Manual

Now on to the Podcast...