Chin WV, Ngai MMI, See KC. Venous excess ultrasound: A mini-review and practical guide for its application in critically ill patients. World J Crit Care Med 2025; 14(2): 101708 [DOI: 10.5492/wjccm.v14.i2.101708]
Corresponding Author of This Article
Wei Ven Chin, MD, MRCP, Doctor, Acute Internal Medicine, Department of Medical, Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia. rachelchin8781@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jun 9, 2025; 14(2): 101708 Published online Jun 9, 2025. doi: 10.5492/wjccm.v14.i2.101708
Venous excess ultrasound: A mini-review and practical guide for its application in critically ill patients
Wei Ven Chin, Melissa Mei Ing Ngai, Kay Choong See
Wei Ven Chin, Acute Internal Medicine, Department of Medical, Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia
Melissa Mei Ing Ngai, Department of Pharmacy, National University Hospital, Singapore 119074, Singapore
Kay Choong See, Department of Medicine, National University Hospital, Singapore 119228, Singapore
Author contributions: Chin WV wrote the manuscript; Ngai MMI participated in drafting sections and reviewing written content; See KC provided supervision and revised the manuscript.
Conflict-of-interest statement: Wei Ven Chin has no conflict of interest to disclose, Melissa Ngai has no conflict of interest to disclose, Kay Choong See has received honoraria from GE Healthcare and Medtronic, and has no other conflicts of interest to disclose.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Ven Chin, MD, MRCP, Doctor, Acute Internal Medicine, Department of Medical, Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia. rachelchin8781@gmail.com
Received: September 24, 2024 Revised: January 21, 2025 Accepted: February 17, 2025 Published online: June 9, 2025 Processing time: 156 Days and 6.2 Hours
Abstract
Advancements in healthcare technology have improved mortality rates and extended lifespans, resulting in a population with multiple comorbidities that complicate patient care. Traditional assessments often fall short, underscoring the need for integrated care strategies. Among these, fluid management is particularly challenging due to the difficulty in directly assessing volume status especially in critically ill patients who frequently have peripheral oedema. Effective fluid management is essential for optimal tissue oxygen delivery, which is crucial for cellular metabolism. Oxygen transport is dependent on arterial oxygen levels, haemoglobin concentration, and cardiac output, with the latter influenced by preload, afterload, and cardiac contractility. A delicate balance of these factors ensures that the cardiovascular system can respond adequately to varying physiological demands, thereby safeguarding tissue oxygenation and overall organ function during states of stress or illness. The Venous Excess Ultrasound (VExUS) Grading System is instrumental in evaluating fluid intolerance, providing detailed insights into venous congestion and fluid status. It was originally developed to assess the risk of acute kidney injury in postoperative cardiac patients, but its versatility has enabled broader applications in nephrology and critical care settings. This mini review explores VExUS’s application and its impact on fluid management and patient outcomes in critically ill patients.
Core Tip: Precise fluid management in critically ill patients is a considerable challenge, as peripheral oedema is common and often complicates accurate assessment of their volume status. The Venous Excess Ultrasound (VExUS) Grading System has emerged as a valuable tool for assessing fluid intolerance and venous congestion across various clinical settings. This mini review emphasizes the application of VExUS to enhance fluid management strategies and its potential to improve patient outcomes. By integrating VExUS into clinical workflows, healthcare providers can better address fluid-related complications and optimize care for patients with complex needs.
