Diagnostic Ultrasound Technology Effectively Evaluates Pathological Venous Backup
A new study published in the Journal of Critical Care in August 2022, led by Hui Wang, MD, from China-Japan Friendship Hospital in Beijing, compares the reliability of Point-of-care ultrasound (POCUS) and conventional systems for assessing Venous Excess Ultrasound (VExUS) in critically ill patients.
The study, which was conducted by the Mayo Clinic, involved 80 critically ill patients. Two blinded residents who had undergone VExUS training independently performed sequential scans on each patient using both POCUS and conventional ultrasound. The images from both ultrasound methods were interpreted by two ICU mentors to establish gold-standard VExUS scores and assess image quality.
The results showed that both ultrasound methods achieved high interrater VExUS grading reliability scores. Hepatic velocities showed insignificant differences between the two methods (ICC > 0.96), indicating a high level of agreement. However, POCUS showed reduced renal vein concordance compared to conventional ultrasound.
POCUS showed comparable grading accuracy to conventional ultrasound (p = 0.747), and it decreased procedural time from eight minutes to five minutes (p < 0.0001). Handheld VExUS, using POCUS, achieves reliable core parameter assessment with 37.5% faster scanning, according to the research findings.
Central venous pressure measured during right heart catheterization is used to assess congestion, but its limited availability and invasiveness are noted. Implementing POCUS in a typical 20-bed ICU could yield annualized time savings exceeding 200 hours.
The VExUS score offers promise as a noninvasive exam, but it is operator-dependent and requires specialized training. The study team developed a short-term VExUS course using POCUS devices for residents, which included didactic learning, simulator training, and mentored practice.
Pathologic venous congestion is a significant cause of harm in critically ill patients. The study's findings suggest that POCUS could be a valuable tool in the assessment of venous congestion, offering a less invasive and more readily available alternative to traditional methods.
For more details, you can find the full study at the provided link.
