(1377) Venous Excess Ultrasound Score Captures Dynamic Changes in Volume Status

Introduction: Assessing volume status is essential to clinical decision making, particularly for critically ill patients. However, studies have shown that physical exam is not a reliable indicator of volume status. The Venous Excess Ultrasound Score (VExUS) was developed as a non-invasive, objective assessment of a patient’s venous congestion using doppler waveforms in the IVC, hepatic, portal, and renal veins. VExUS has been shown to be associated with right atrial pressure as measured by right heart catheterization, validating it as a measure of volume status. However, the technique has not been used to assess dynamic volume status changes. The purpose of this study was to collect VExUS scores before and after intermittent hemodialysis (iHD) to assess whether VExUS can capture dynamic changes in volume status.

Methods: Patients with ESRD undergoing iHD underwent a VExUS examination and POCUS of 8 lung fields as a measure of pulmonary congestion before and after their iHD session. We conducted paired T-tests to assess differences between VExUS scores and number of lung fields with B-lines before and after hemodialysis. Data collection for this study is ongoing.

Results: 26 paired exams from 13 patients, 9 male and 4 female, underwent VExUS and lung POCUS before and after iHD. The pre-HD mean VExUS score was 1.8 and the post-HD mean VExUS score was 1 (P = 0.04), and the pre-HD mean number of lung fields with B-lines was 1.5 with a post-HD mean number of lung fields with B lines of 0.6 (P = 0.05).

Conclusions: The change in VExUS scores pre- and post- hemodialysis suggests that it could be used as a way of measuring dynamic changes in volume status. This could be of particular use to assess response to fluid resuscitation, a clinical scenario in which volume status changes quickly. As data collection continues, analyses will be conducted to evaluate associations between VExUS and changes in volume status with a larger sample size. While these results indicate the potential to use VExUS to assess changes in volume status, future areas of research include assessing its interrater reliability and reproducibility. Additionally, future studies using VExUS in patients receiving fluid resuscitation should be conducted, to assess whether it could be used as a way of helping guide fluid resuscitation.