Título:
Cuantificación del exceso venoso por ultrasonido (VexUS) como predictor de injuria renal en cirugía cardíaca.
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Autor:
Aguirrezábal, Josefina
Aunés, Sofía
Cabral, Hernán
Lorenzo, César
Meerhoff, Agustina
Mussini, Tatiana
Aunés, Sofía
Cabral, Hernán
Lorenzo, César
Meerhoff, Agustina
Mussini, Tatiana
Tutor:
Gómez, Antonella
Pécora, Matías
Pécora, Matías
Tipo de documento:
Monografía
Editor:
Palabras clave:
VExUS
Cirugía cardíaca
Injuria renal aguda
Congestión sistémica
Lactato
Cardiac surgery
Acute kidney injury
Systemic congestion
Lactate
Cirugía cardíaca
Injuria renal aguda
Congestión sistémica
Lactato
Cardiac surgery
Acute kidney injury
Systemic congestion
Lactate
Descriptores:
HIPEREMIA
CIRUGÍA TORÁCICA
LESIÓN RENAL AGUDA
ULTRASONOGRAFÍA
CIRUGÍA TORÁCICA
LESIÓN RENAL AGUDA
ULTRASONOGRAFÍA
Año de publicación:
2025
Contenido:
Resumen:
Introducción: La congestión venosa en el postoperatorio de cirugía cardíaca aumenta el riesgo de injuria renal aguda (IRA), fenómeno multifactorial favorecido por exceso de fluidos, falla ventricular derecha e inflamación sistémica. “Venous Excess Ultrasound Score” (VExUS) es un sistema de clasificación de la congestión venosa por ultrasonido de la vena cava inferior (VCI) y de los patrones de flujo hepático y renal. El objetivo fue analizar la utilidad de VExUS para predecir IRA y complicaciones en cirugía cardíaca en un hospital universitario de Uruguay en 2025.
Métodos: Estudio observacional, analítico y prospectivo en pacientes adultos sometidos a cirugía cardíaca coordinada e ingresados en una Unidad de Cuidados Intensivos. Se realizó ecografía VExUS (pre y posoperatorio) y ecocardiografía posoperatoria. Se registraron variables clínicas, hemodinámicas,bioquímicas, ecocardiográficas a partir de las historias clínicas. Se realizaron descripciones y análisis comparativos entre variables relevantes (VExUS, IRA, lactato) y modelos de regresión logística simple y múltiple (lactato, PVC, VIS, EuroSCORE II) con IRA como variable dependiente.
Resultados: Se incluyeron 40 pacientes. La incidencia de IRA fue 17,5 %. Tras la intervención se observó un incremento de patrones de flujo de mayor severidad. Se vio una tendencia a mayores chances de IRA en pacientes con congestión moderada respecto a los sin congestión. Considerando patrones de flujo alterados pese a tener VCI no pletórica, todos los casos de IRA se presentaron en pacientes con VExUS alterado. El lactato, el pH y la PVC se asociaron a IRA; el lactato fue factor de riesgo y la PVC se presentó como protector pero con resultados discordantes según otras variables.
Conclusión: Se identificaron limitaciones del protocolo VExUS relacionadas con el uso de la VCI como criterio de entrada; se propone una nueva categoría. Se requieren estudios con mayor tamaño muestral para explorar la validez de la propuesta.
Introduction:Venous congestion after cardiac surgery increases the risk of acute kidney injury (AKI), a multifactorial condition influenced by fluid overload, right ventricular dysfunction, and systemic inflammation. The Venous Excess Ultrasound Score (VExUS) assesses venous congestion using ultrasound evaluation of the inferior vena cava (IVC) and hepatic and renal Doppler flow patterns. The aim was to evaluate the utility of VExUS in predicting AKI and postoperative complications in cardiac surgery patients at a university hospital in Uruguay in 2025. Methods: This was an observational, analytical, and prospective study conducted in adult patients undergoing elective cardiac surgery and admitted to an Intensive Care Unit. VExUS ultrasound was performed (pre- and postoperatively) as well as postoperative echocardiography. Clinical, hemodynamic, ultrasound, and biochemical variables were obtained from medical records. Descriptive analyses, comparative assessments of key variables (VExUS, AKI, lactate), and simple and multivariable logistic regression models (lactate, CVP, VIS, EuroSCORE II) were performed, with AKI as the dependent variable. Results: 40 patients were included. The incidence of AKI was 17.5%. After surgery, an increase in the proportion of Doppler flow patterns indicating greater severity was observed. A trend toward higher AKI risk was noted in patients with moderate congestion compared with those without congestion. Among patients showing altered Doppler patterns despite a non-plethoric IVC, all AKI cases occurred in those with abnormal postoperative VExUS scores. Lactate, pH, and central venous pressure (CVP) were associated with AKI; lactate acted as a risk factor, while CVP appeared protective, although with inconsistent findings across other variables. Conclusion: Limitations of the VExUS protocol related to the use of the IVC as an entry criterion were identified, and a new category is proposed. Larger studies are required to assess the validity of the proposed classification.
Introduction:Venous congestion after cardiac surgery increases the risk of acute kidney injury (AKI), a multifactorial condition influenced by fluid overload, right ventricular dysfunction, and systemic inflammation. The Venous Excess Ultrasound Score (VExUS) assesses venous congestion using ultrasound evaluation of the inferior vena cava (IVC) and hepatic and renal Doppler flow patterns. The aim was to evaluate the utility of VExUS in predicting AKI and postoperative complications in cardiac surgery patients at a university hospital in Uruguay in 2025. Methods: This was an observational, analytical, and prospective study conducted in adult patients undergoing elective cardiac surgery and admitted to an Intensive Care Unit. VExUS ultrasound was performed (pre- and postoperatively) as well as postoperative echocardiography. Clinical, hemodynamic, ultrasound, and biochemical variables were obtained from medical records. Descriptive analyses, comparative assessments of key variables (VExUS, AKI, lactate), and simple and multivariable logistic regression models (lactate, CVP, VIS, EuroSCORE II) were performed, with AKI as the dependent variable. Results: 40 patients were included. The incidence of AKI was 17.5%. After surgery, an increase in the proportion of Doppler flow patterns indicating greater severity was observed. A trend toward higher AKI risk was noted in patients with moderate congestion compared with those without congestion. Among patients showing altered Doppler patterns despite a non-plethoric IVC, all AKI cases occurred in those with abnormal postoperative VExUS scores. Lactate, pH, and central venous pressure (CVP) were associated with AKI; lactate acted as a risk factor, while CVP appeared protective, although with inconsistent findings across other variables. Conclusion: Limitations of the VExUS protocol related to the use of the IVC as an entry criterion were identified, and a new category is proposed. Larger studies are required to assess the validity of the proposed classification.
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Udelar. FM
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Citación:
Aguirrezábal J, Aunés S, Cabral H y otros. Cuantificación del exceso venoso por ultrasonido (VexUS) como predictor de injuria renal en cirugía cardíaca [en línea]. Monografía de Pre Grado. Montevideo: Udelar. FM, 2025. 31 p.
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https://hdl.handle.net/20.500.12008/57119
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Atribución/Reconocimiento-NoComercial-SinDerivados 4.0 Internacional
Cobertura geográfica:
URUGUAY
MONTEVIDEO
MONTEVIDEO
Cobertura temporal:
Junio-Septiembre de 2025
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| Ficheros | Descripción | Tamaño | Formato | ||
|---|---|---|---|---|---|
| G14-2025. Cuantificación del exceso venoso por ultrasonido (VexUS) como predictor de injuria renal en cirugía cardíaca.pdf | — | 2.18 MB | Adobe PDF |
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