Medición de la congestión venosa empleando la ecografía: protocolo VExUS / Measurement of venous congestion using ultrasound: the vexus protocol

Acute Heart Failure (AHF) is a clinical syndrome characterized by the appearance or worsening of cardinal symptoms derived from venous congestion,which carries a high morbidity and mortality burden. Unfortunately, in current clinical practice, common markers such as patient’s history, physicalexamination, and complementary tests are not sensitive enough for reliableassessment of volume status. In recent years, the use of Point-of-Care Ultrasound (POCUS) has been consolidated as a useful tool to detect the presenceand degree of venous congestion, providing a substantial improvement in thediagnosis and therapeutic management of these patients. In combination,pulmonary ultrasound, echocardiography and renal, suprahepatic and portalvenous flow patterns (VExUS protocol), we will be able better understand thevenous pathophysiology. This will allow us to identify the hemodynamic phenotype in patients with heart failure or to determine the target organ damagederived from heart failure (i.e., cardiorenal syndrome). All this would allowus to make an individualized adjustment of the treatment, as well as to serve as a prognostic marker of the evolution of the disease. (AU)

La Insuficiencia Cardíaca Aguda (ICA) es una entidad clínica caracterizadapor la aparición o empeoramiento de síntomatología cardinal derivada dela congestión venosa, relacionado con una alta morbi-mortalidad. En lapráctica clínica actual, los marcadores habituales como son la anamnesis,exploración física y pruebas complementarias, precisan del apoyo de otrastécnicas para valorar de forma fiable el estado congestivo de los pacientes.En los últimos años, se ha consolidado el uso de la Ecografía Point-of-Care(POCUS) como una herramienta útil para detectar la presencia y el grado decongestión venosa, aportando una mejora sustancial en el diagnóstico y enel manejo terapéutico de estos enfermos. Combinando la ecografía pulmonar, ecocardiografía y los patrones de flujo venoso renal, suprahepática yporta (protocolo VExUS), nos permite conocer mejor la fisiopatología de lacongestión venosay nos permitirá identificar el fenotipo hemodinámico enpacientes con insuficiencia cardíaca o determinar la lesión de órgano dianaderivada de la insuficiencia cardíaca. Todo ello nos puede permitir hacer unajuste individualizado del tratamiento, así como servir de marcador pronóstico de la evolución de la enfermedad. (AU)

Importance of Lung Ultrasound Follow-Up in Patients Who Had Recovered from Coronavirus Disease 2019: Results from a Prospective Study.

There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasounds, however, their role in predicting the prognosis has yet to be explored. Our objective was to assess the usefulness of lung ultrasound in the short-term follow-up (1 and 3 months) of patients with SARS-CoV-2 pneumonia, and to describe the progression of the most relevant lung ultrasound findings. We conducted a prospective, longitudinal and observational study performed in patients with confirmed COVID-19 who underwent a lung ultrasound examination during hospitalization and repeated it 1 and 3 months after hospital discharge. A total of 96 patients were enrolled. In the initial ultrasound, bilateral involvement was present in 100% of the patients with mild, moderate or severe ARDS. The most affected lung area was the posteroinferior (93.8%) followed by the lateral (88.7%). Subpleural consolidations were present in 68% of the patients and consolidations larger than 1 cm in 24%. One month after the initial study, only 20.8% had complete resolution on lung ultrasound. This percentage rose to 68.7% at 3 months. Residual lesions were observed in a significant percentage of patients who recovered from moderate or severe ARDS (32.4% and 61.5%, respectively). In conclusion, lung injury associated with COVID-19 might take time to resolve. The findings in this report support the use of lung ultrasound in the short-term follow-up of patients recovered from COVID-19, as a radiation-sparing, easy to use, novel care path worth exploring.