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The VExUS concept uses Doppler ultrasound of the inferior vena cava, hepatic vein, portal vein and intrarenal vein to grade systemic venous congestion. A prospective ICU study evaluated whether higher VExUS grades were associated with major adverse kidney events within 30 days. In the cohort, severe venous congestion was uncommon, but patients with VExUS grade 2 or higher had substantially greater odds of MAKE-30. The study also found moderate-to-excellent agreement between observers, supporting the feasibility of the technique. This matters because conventional fluid assessment often focuses on whether a patient is fluid responsive, while ignoring whether the patient can tolerate additional fluid. Venous congestion can impair renal perfusion and contribute to organ dysfunction even when blood pressure appears adequate. CritiCARE's sessions on non-invasive haemodynamic monitoring, VExUS and AKI directly reflect this evolving approach. For HCPs, VExUS should be viewed as an adjunct rather than a stand-alone diagnostic test. Its greatest value may come from integrating it with the patient's haemodynamics, lung ultrasound, cardiac function, urine output and cumulative fluid balance. The broader clinical message is that fluid stewardship requires attention to both responsiveness and tolerance.
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The VExUS concept uses Doppler ultrasound of the inferior vena cava, hepatic vein, portal vein and intrarenal vein to grade systemic venous congestion. A prospective ICU study evaluated whether higher VExUS grades were associated with major adverse kidney events within 30 days. In the cohort, severe venous congestion was uncommon, but patients with VExUS grade 2 or higher had substantially greater odds of MAKE-30. The study also found moderate-to-excellent agreement between observers, supporting the feasibility of the technique. This matters because conventional fluid assessment often focuses on whether a patient is fluid responsive, while ignoring whether the patient can tolerate additional fluid. Venous congestion can impair renal perfusion and contribute to organ dysfunction even when blood pressure appears adequate. CritiCARE's sessions on non-invasive haemodynamic monitoring, VExUS and AKI directly reflect this evolving approach. For HCPs, VExUS should be viewed as an adjunct rather than a stand-alone diagnostic test. Its greatest value may come from integrating it with the patient's haemodynamics, lung ultrasound, cardiac function, urine output and cumulative fluid balance. The broader clinical message is that fluid stewardship requires attention to both responsiveness and tolerance.
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