Fellow University of Texas Southwestern Medical School Dallas, Texas, United States
Background: Fluid resuscitation is a core component of shock resuscitation, but caution must be exercised with fluid administration due to the well-recognized association between fluid overload and mortality. The pathophysiology of this is complex, likely involving the development of venous congestion and interstitial edema with resulting circulatory dysfunction, impaired perfusion, and multiorgan failure. Venous excess ultrasound (VExUS) is a novel point-of-care ultrasound protocol using visceral venous doppler to tackle the challenging task of intravascular volume assessment. While abnormal VExUS grades have been shown in adults to be strongly predictive of the development of kidney injury, minimal data exist for the implementation and clinical significance of VExUS in pediatrics. Objective: The primary aim of this study is to evaluate the feasibility of reliably obtaining and interpreting VExUS grading in pediatric patients. Additionally, exploratory clinical data will be collected to guide power analysis for future validation studies. Design/Methods: This study is approved under UT Southwestern Medical Center IRB. This is a prospective cohort study using convenience sampling of two cohorts. Cohort 1 includes pediatric critical care patients receiving at least 40 mL/kg fluid boluses within a 24-hour period. Cohort 2 includes patients with admitted with acute decompensated heart failure. Patients will undergo VExUS scan by the primary sonographer with up to two follow-up scans for patients with abnormal VExUS grading. Additionally, a subset of patients will undergo a duplicate scan by a second sonographer to ensure scan reproducibility. All images will be reviewed with a VExUS content expert. Relevant clinical information including urine output, fluid balance, renal biomarkers, and echocardiographic data will be extracted from the medical record. Cohen’s kappa will be used to assess interrater reliability between each sonographer and with the VExUS content expert. The study has begun enrollment with expected enrollment completion by March 2023 and data analysis by April 2023.
