EMCrit Podcast 263 – The Venous Side – Part 1 – VEXUS Score with Phillipe Rola

01.14.2020 - By Scott D. Weingart, MD FCCM Play

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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 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