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Hemodynamics Management

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VExUS for evaluation of venous congestion in a patient with mixed cardiogenic and distributive shock, acute respiratory failure, bibasilar infiltrates, and acute kidney injury.


Step 1: IVC diameter is 2.5 cm


Step 2: hepatic vein doppler assessment showing reversal of the systolic wave.



Step 3: Portal vein doppler assessment showing more than 50% variability


That will make it VExUS grade 3 as there are2 severe abnormal patterns.

Of note, we could not detect renal vein flow doppler.

sufian arafa
Ibrahim Ameen
alaaghanem2006
Hayat Sahlool
Ibrahim Ameen
Ibrahim Ameen
Nov 25, 2023

Very beautiful demonstration

It helps to suggest offloading rather than fluid resuscitation

It requires stady hands and minimal pt movement (abd wise) in order to catch the image in PW mode

If my memory serves me right, there were only limited data from multiple case report

No strong data to suggest outcome

Yet a useful tool to add on for the management

If we have research, i think mortality outcome, Cr trend, O2 requirements, vasopressors doses would be excellent markers for monitoring

Thank you Dr Mazen for your amazing continuous contribution to enriching our knowledge

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