Venous Congestion Assessed by Venous Excess Ultrasound (VExUS) and Acute Kidney Injury in Children with Right Ventricular Dysfunction

Rajeswari Natraj; Anu Kirthiga Bhaskaran; Philippe Rola; Korbin Haycock; Matthew Tt Siuba; Suchitra Ranjit

doi:10.5005/jp-journals-10071-24705

Venous Congestion Assessed by Venous Excess Ultrasound (VExUS) and Acute Kidney Injury in Children with Right Ventricular Dysfunction

Indian J Crit Care Med. 2024 May;28(5):447-452. doi: 10.5005/jp-journals-10071-24705.

Authors

Rajeswari Natraj¹, Anu Kirthiga Bhaskaran², Philippe Rola³, Korbin Haycock⁴, Matthew Tt Siuba⁵, Suchitra Ranjit⁶

Affiliations

¹ Pediatric Intensive Care Unit and Cardiothoracic Services, Apollo Children's Hospital, Chennai, Tamil Nadu, India.
² Pediatric Intensive Care Unit, Apollo Children's Hospital, Chennai, Tamil Nadu, India.
³ Intensive Care Unit, Santa Cabrini Hospital, CEMTL; Intensive Care Unit, University of Montreal, Montreal, Canada.
⁴ Emergency Department, Riverside University Health System Medical Center, Moreno Valley, California, Loma Linda, United States.
⁵ Intensive Care Unit, Department of Critical Care Medicine, Integrated Hospital Care, Cleveland, Ohio, United States.
⁶ Department of Pediatric Intensive Care Unit, Apollo Children's Hospital, Chennai, Tamil Nadu, India.

Abstract

Background: Right ventricular dysfunction (RVD) is a complication following congenital cardiac surgery in children and can lead to systemic venous congestion, low cardiac output, and organ dysfunction. Venous congestion can be transmitted backwards and adversely affect encapsulated organs such as the kidneys.

Primary objective: To investigate the association between systemic venous congestion, as estimated by Venous Excess Ultrasound (VExUS), and the occurrence of acute kidney injury (AKI) in children with RVD following congenital heart surgery. Secondary objectives included comparing changes in VExUS scores after initiating treatment for RVD and venous congestion.

Methods and results: This was a prospective observational study in children with RVD. The VExUS study was performed on day 1, day 2, and day 3 and categorized as VExUS-1, VExUS-2, and VExUS-3. Among 43 patients with RVD and dilated inferior vena cava, 19/43 (44%), 10/43 (23%), and 12/43 (28%) were VExUS-2 and VExUS-3, respectively. There was an association between severe RVD and elevated pulmonary artery systolic pressures and a VExUS score >2. A significant association was observed between central venous pressure (CVP) measurements and VExUS. Among 31 patients with a high VExUS score >2, 18 (58%) had AKI. Additionally, improvement in CVP and fluid balance was associated with improving VExUS scores following targeted treatment for RVD.

Conclusion: VExUS serves as a valuable bedside tool for diagnosing and grading venous congestion through ultrasound Doppler. An elevated VExUS score was associated with the occurrence of AKI, and among the components of VExUS, portal vein pulsatility may be useful as a predictor of AKI.

How to cite this article: Natraj R, Bhaskaran AK, Rola P, Haycock K, Siuba MTT, Ranjit S. Venous Congestion Assessed by Venous Excess Ultrasound (VExUS) and Acute Kidney Injury in Children with Right Ventricular Dysfunction. Indian J Crit Care Med 2024;28(5):447-452.

Keywords: Acute kidney injury; Children; Right ventricular dysfunction; Venous congestion; Venous excess ultrasound.