Utility of bedside ultrasound derived hepatic and renal parenchymal flow patterns to guide management of acute kidney injury

Purpose of review Ideal fluid management of critically ill patients is maintaining an adequate perfusion pressure but avoiding venous congestion. Venous excess ultrasound score (VExUS) quantifies venous congestion to guide the management of fluid balance. Recent findings VExUS of abdominal veins measures fluid tolerance and helps clinicians avoid congestion. VExUS scoring predicts the development of acute kidney injury (AKI) that is a common hospital problem resulting in higher mortality and morbidity. VExUS can predict patients at risk of developing AKI post cardiac surgery. VExUS has been associated with an increase in adverse outcomes in a general intensive care population. Hepatic vein ultrasound can manifest as a sequela of right heart failure and pulmonary hypertension. Intrarenal congestion suggests poorer prognosis in heart failure patients. VExUS score has been used in decision-making to remove fluid in patients with cardiorenal syndrome. VExUS scoring may help curtail overly aggressive fluid resuscitation for patients with septic shock and help avoid iatrogenic ‘salt water drowning’ Summary We summarize the technique and clinical practice of VExUS to help guide fluid balance across different populations of critically ill patients.