Ultrasonido de la congestión venosa sistémica (VExUS) mediante ecocardiografía transesofágica (T-VExUS) en pacientes críticos: generalidades y descripción de la técnica
DOI:
https://doi.org/10.37615/retic.v9n1a3Palabras clave:
ultrasonografía, ultrasonografía en el punto de atención, sistema venoso, congestión, insuficiencia cardíacaResumen
Introducción. La congestión venosa sistémica es un factor de morbilidad y mortalidad en la insuficiencia cardíaca y otras condiciones críticas, que puede identificarse mediante ultrasonografía transtorácica y abdominal a través del puntaje VExUS con el objetivo de predecir el desarrollo de insuficiencia renal aguda después de una cirugía cardíaca, así como en otros escenarios dentro de las Unidades de Cuidados Intensivos (UCI). Hay poca información en la literatura sobre la realización de este examen a través del abordaje transesofágico (T-VExUS) como complemento al ultrasonido en el punto de atención del paciente en estado crítico. Objetivo. Sintetizar la evidencia actual sobre las generalidades del examen VExUS y describir la técnica del abordaje transesofágico, así como las posibles ventajas y limitaciones respecto al abordaje abdominal. Métodos. Revisión narrativa de PubMed y Google Scholar (septiembre 2015-septiembre 2025) complementado por estudios relevantes previos. Las imágenes se obtuvieron como parte de la evaluación hemodinámica mediante ETE en la UCI y con las ventanas estandarizadas, tanto esofágicas como transgástricas, con algunas manipulaciones adicionales de la sonda. Contenido clave y hallazgos. El T-VExUS puede aportar datos decisivos sobre el estado hemodinámico en la UCI. Es una alternativa eficaz que resuelve los problemas de visibilidad del método convencional en pacientes graves, especialmente cuando se combina con una ETE. Conclusión. El T-VExUS es una herramienta hemodinámica fundamental que permite evaluar la congestión venosa en pacientes críticos cuando las limitaciones físicas del entorno clínico imposibilitan el abordaje abdominal estándar.
Descargas
Citas
- Koratala A, Romero-González G, Soliman-Aboumarie H, Kazory A. Unlocking the potential of VExUS in assessing venous congestion: the art of doing it right. Cardiorenal Med. 2024;14(1):350-374. doi: https://doi.org/10.1159/000539469
- Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53(7):589-596. doi: https://doi.org/10.1016/j.jacc.2008.05.068
- Lucas C, Johnson W, Hamilton MA, Fonarow GC, Woo MA, Flavell CM, et al. Freedom from congestion predicts good survival despite previous class IV symptoms of heart failure. Am Heart J. 2000;140(6):840-847. doi: https://doi.org/10.1067/mhj.2000.110933
- Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B, et al. Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial. Eur Heart J. 2013;34(11):835-843. doi: https://doi.org/10.1093/eurheartj/ehs444
- Lala A, McNulty SE, Mentz RJ, Dunlay SM, Vader JM, AbouEzzeddine OF, et al. Relief and recurrence of congestion during and after hospitalization for acute heart failure: insights from Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF). Circ Heart Fail. 2015;8(4):741-748. doi: https://doi.org/10.1161/CIRCHEARTFAILURE.114.001957
- Rubio-Gracia J, Demissei BG, Ter Maaten JM, Cleland JG, O'Connor CM, Metra M, et al. Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure. Int J Cardiol. 2018;258:185-191. doi: https://doi.org/10.1016/j.ijcard.2018.01.067
- Catalano D, Caruso G, DiFazzio S, Carpinteri G, Scalisi N, Trovato GM. Portal vein pulsatility ratio and heart failure. J Clin Ultrasound. 1998;26(1):27-31. doi: https://doi.org/10.1002/(sici)1097-0096(199801)26:1<27::aid-jcu6>3.0.co;2-l
- Beaubien-Souligny W, Benkreira A, Robillard P, Bouabdallaoui N, Chassé M, Desjardins G, et al. Alterations in portal vein flow and intrarenal venous flow are associated with acute kidney injury after cardiac surgery: a prospective observational cohort study. J Am Heart Assoc. 2018;7(19):e009961. doi: https://doi.org/10.1161/JAHA.118.009961
- Iida N, Seo Y, Sai S, Machino-Ohtsuka T, Yamamoto M, Ishizu T, et al. Clinical implications of intrarenal hemodynamic evaluation by Doppler ultrasonography in heart failure. JACC Heart Fail. 2016;4(8):674-682. doi: https://doi.org/10.1016/j.jchf.2016.03.016
- Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J. 2020;12(1):16. doi: https://doi.org/10.1186/s13089-020-00163-w
- Assavapokee T, Rola P, Assavapokee N, Koratala A. Decoding VExUS: a practical guide for excelling in point-of-care ultrasound assessment of venous congestion. Ultrasound J. 2024;16(1):48. doi: zzhttps://doi.org/10.1186/s13089-024-00396-z
- Klompmaker P, Mousa A, Allard DJ, Hagen BSH, Bánki T, Vermeulen W, et al. The association between venous excess ultrasound grading system (VExUS) and major adverse kidney events after 30 days in critically ill patients: A prospective cohort study. J Crit Care. 2025;88:155097. doi: https://doi.org/10.1016/j.jcrc.2024.155097
- Longino A, Martin K, Leyba K, Siegel G, Gill E, Douglas IS, et al. Correlation between the VExUS score and right atrial pressure: a pilot prospective observational study. Crit Care. 2023;27(1):205. https://doi.org/10.1186/s13054-023-04471-0
- Cheong I, Amador EDO, Gómez RA, Vilariño FMÁ, Furche MA, Tamagnone FM. Evaluating the utility of portal vein pulsatility index for detecting fluid unresponsiveness in the intensive care unit. J Cardiothorac Vasc Anesth. 2023;37(9):1677-1682. https://doi.org/10.1053/j.jvca.2023.05.039
- von Herbay A, Frieling T, Häussinger D. Association between duplex Doppler sonographic flow pattern in right hepatic vein and various liver diseases. J Clin Ultrasound. 2001;29(1):25-30. https://doi.org/10.1002/1097-0096(200101)29:1<25::aid-jcu4>3.0.co;2-a
- Jeong SH, Jung DC, Cho SH, Kim SH. Renal venous doppler ultrasonography in normal subjects and patients with diabetic nephropathy: value of venous impedance index measurements. J Clin Ultrasound. 2011;39(9):512-8. https://doi.org/10.1002/jcu.20835
- Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):685-713. doi: https://doi.org/10.1016/j.echo.2010.05.010
- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-70. doi: https://doi.org/10.1093/ehjci/jev014
- Khandwalla R, Kimchi A. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound. 2016;14(1):33. doi: https://doi.org/10.1186/s12947-016-0076-1
- Seo Y, Iida T, Yamamoto Y, Ishizu T, Kato M, Kawano T, et al. Estimation of central venous pressure using the ratio of short to long diameter from cross-sectional images of the inferior vena cava. J Am Soc Echocardiogr. 2017 May;30(5):461-467. doi: 10.1016/j.echo.2016.12.002.
-Koratala A (2020) Pitfalls of inferior vena cava M-mode. Avaiable via
NEPHROPOCUS. Available from https://nephropocus.com/2020/07/10/pitfalls-of-inferior-vena-cava-m-mode/
- Via G, Tavazzi G, Price S. Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view. Intensive Care Med. 2016;42(7):1164-7. doi: https://doi.org/10.1007/s00134-016-4357-9
- Wachsberg RH, Sebastiano LLS, Levine CD. Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure. Abdom Imaging. 1998;23(1):99-102. doi: https://doi.org/10.1007/s002619900295
- Rola P, Haycock K, Spiegel R. What every intensivist should know about the IVC. J Crit Care. 2024;80:154455. doi: https://doi.org/10.1016/j.jcrc.2023.154455
-Pinto FJ, Wranne B, St Goar FG, Schnittger I, Popp RL. Hepatic venous flow assessed by transesophageal echocardiography. J Am Coll Cardiol. 1991;17(7):1493-8. doi: https://doi.org/10.1016/0735-1097(91)90637-o
- Pinto FJ, Wranne B, St Goar FG, Schnittger I, Popp RL. Systemic venous flow during cardiac surgery examined by intraoperative transesophageal echocardiography. Am J Cardiol. 1992;69(4):387-93. doi: https://doi.org/10.1016/0002-9149(92)90239-u
- Eljaiek R, Cavayas YA, Rodrigue E, Desjardins G, Lamarche Y, Toupin F, et al. High postoperative portal venous flow pulsatility indicates right ventricular dysfunction and predicts complications in cardiac surgery patients. Br J Anaesth. 2019;122(2):206-214. doi: https://doi.org/10.1016/j.bja.2018.09.028
- Denault AY, Azzam MA, Beaubien-Souligny W. Imaging portal venous flow to aid assessment of right ventricular dysfunction. Can J Anesth. 2018;65(11):1260-1261. doi: https://doi.org/10.1007/s12630-018-1125-z
- Beaubien-Souligny W, Eljaiek R, Fortier A, Lamarche Y, Liszkowski M, Bouchard J, et al. The Association Between Pulsatile Portal Flow and Acute Kidney Injury after Cardiac Surgery: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth. 2018;32(4):1780-1787. doi: https://doi.org/10.1053/j.jvca.2017.11.011
- Denault AY, Beaubien-Souligny W, Elmi-Sarabi M, Eljaiek R, El-Hamamsy I, Lamarche Y, et al. Clinical significance of portal hypertension diagnosed with bedside ultrasound after cardiac surgery. Anesth Analg. 2017;124(4):1109-1115. doi: https://doi.org/10.1213/ANE.0000000000001812
- Martin KC, Gill EA, Douglas IJ, Siegel GS, Longino A, Burke J, et al. Evaluation of a modified venous excess ultrasound (VExUS) protocol for estimation of venous congestion: a cohort study. Ultrasound J. 2025;17(1):7. doi: https://doi.org/10.1186/s13089-025-00411-x
- Sakai M, Yoshida K, Shirai K, Kitano F, Shibagaki Y, Yazawa M. Nephrology-oriented point of care ultrasound education and subsequence: Clinical usefulness for nephrology fellows from a Japanese teaching hospital. Nephrology (Carlton). 2025;30(6):e70060. doi: https://doi.org/10.1111/nep.14392
-Wong A, Spiegel R, Elhassan M, Rola P, Al-Saeed M, Amador EDO, et al. Utility of the Venous Excess Ultrasound (VEXUS) score to track dynamic change in volume status in patients undergoing fluid removal during haemodialysis—the ACUVEX study. Ultrasound J. 2024;16(1):23. doi: https://doi.org/10.1186/s13089-024-00370-9
- Gudiño-Bravo P, Posada-Martinez EL, Cano-Nieto MM, Ibarra-Marquez ND, Leal-Escobar G, Madero M, et al. Ultrasonographic evaluation of systemic venous congestion in maintenance hemodialysis patients during fluid removal. Blood Purif. 2025;54(1):62-70. doi: https://doi.org/10.1159/000542012
- Kararmaz A, Kemal Arslantas M, Cinel I. Renal resistive index measurement by transesophageal echocardiography: comparison with translumbar ultrasonography and relation to acute kidney injury. J Cardiothorac Vasc Anesth. 2015;29(4):875-80. doi: https://doi.org/10.1053/j.jvca.2014.11.003.
- Bandyopadhyay S, Das RK, Paul A, Bhunia KS, Roy D. A transesophageal echocardiography technique to locate the kidney and monitor renal perfusion. Anesth Analg. 2013;116(3):549-54. doi: https://doi.org/10.1213/ANE.0b013e31827ab3b1
- Khan AA, Saeed H, Haque IU, Iqbal A, Du D, Koratala A. Point-of-care ultrasonography spotlight: Could venous excess ultrasound serve as a shared language for internists and intensivists? World J Crit Care Med. 2024;13(2):93206. doi: https://doi.org/10.5492/wjccm.v13.i2.93206
- Argaiz ER, Koratala A, Reisinger N. Comprehensive assessment of fluid status by point-of-care ultrasonography. Kidney360. 2021;2(8):1326-1338. doi: https://doi.org/10.34067/KID.0001432021
- Kashani K, Omer T, Shaw AD. The intensivist's perspective of shock, volume management, and hemodynamic monitoring. Clin J Am Soc Nephrol. 2022;17(5):706-716. doi: https://doi.org/10.2215/CJN.14191021
- Vignon P, Merz TM, Vieillard-Baron A. Ten reasons for performing hemodynamic monitoring using transesophageal echocardiography. Intensive Care Med. 2017;43(7):1048-1051. doi: https://doi.org/10.1007/s00134-017-4716-1.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 Juan Antonio Calderón González, José María Hernández Hernández
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
RETIC se distribuye bajo la licencia Creative Commons Reconocimiento-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0 que permite compartir, copiar y redistribuir el material en cualquier medio o formato, bajo los siguientes términos:
- Reconocimiento: debe otorgar el crédito correspondiente, proporcionar un enlace a la licencia e indicar si se realizaron cambios. Puede hacerlo de cualquier manera razonable, pero no de ninguna manera que sugiera que el licenciante lo respalda a usted o su uso.
- No comercial: no puede utilizar el material con fines comerciales.
- No Derivados: si remezcla, transforma o construye sobre el material, no puede distribuir el material modificado.
- Sin restricciones adicionales: no puede aplicar términos legales o medidas tecnológicas que restrinjan legalmente a otros de hacer cualquier cosa que permita la licencia.
