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Venous Excess Ultrasound (VExUS Grading to Assess Perioperative Fluid Status for Noncardiac Surgeries: a Prospective Observational Pilot Study.
Magin, Justin C; Wrobel, Jacob R; An, Xinming; Acton, Jacob; Doyal, Alexander; Jia, Shawn; Krakowski, James C; Schoenherr, Jay; Serrano, Ricardo; Flynn, David; McLean, Duncan; Grant, Stuart A.
Affiliation
  • Magin JC; University of North Carolina School of Medicine Chapel Hill, NC USA.
  • Wrobel JR; University of North Carolina School of Medicine Chapel Hill, NC USA.
  • An X; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • Acton J; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • Doyal A; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • Jia S; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • Krakowski JC; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • Schoenherr J; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • Serrano R; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • Flynn D; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • McLean D; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
  • Grant SA; Department of Anesthesiology, University of North Carolina Chapel Hill, NC USA.
POCUS J ; 8(2): 223-229, 2023.
Article in En | MEDLINE | ID: mdl-38099161
ABSTRACT

Objectives:

Perioperative fluid administration impacts the rate of complications following surgery. VExUS grading system is a standardized point of care ultrasound (POCUS)-based, comprehensive method to assess volume status. VExUS could serve as a tool to guide fluid management, if validated perioperatively. The primary aim was to assess the success rate of obtaining required windows for VExUS grading , as well as the feasibility within a perioperative setting among noncardiac surgery. Further, this study describes the incidence of perioperative venous congestion and associations with 30-day postoperative complications.

Methods:

This observational study was conducted in non-critically ill adults undergoing noncardiac surgery. Patients were scanned preoperatively, in the post anesthesia care unit (PACU), and 24 hours postoperatively for venous congestion. Researchers retrospectively captured 30-day complications for multivariate analyses.

Results:

The cohort included 69 participants. Ninety-one percent of scans over all timepoints were successfully completed. Pre-operatively, 57 (83%) scans were Grade 0, and 11 (16%) were Grade 1. Venous congestion was observed in 29 (44%) patients in the PACU (n=66). 22 (33%) patients were Grade 1, while 7 (11%) were Grade 2. At 24 hours (n=63), 31 patients (49%) had venous congestion 20 (32%) Grade 1 and 11 (17%) Grade 2. Of the pre-operative Grade 0, 28 (50%) had at least one postoperative scan with venous congestion. No patients were Grade 3 at any timepoint. The 30-day complication rate was 32% (n=22). Eleven (16%) patients developed acute kidney injury (AKI). There was no statistically significant association between VExUS grading and all-cause complications or AKI.

Conclusion:

This study demonstrates that perioperative VExUS scoring is a feasible tool among a variety of noncardiac surgeries. We highlight that venous congestion is common and increases postoperatively within non-ICU populations. Larger studies are needed to assess the relationship between VExUS grading and postoperative complications.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: POCUS J Year: 2023 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: POCUS J Year: 2023 Document type: Article