Assessing the venous system: Correlation of mean systemic filling pressure with the venous excess ultrasound grading system in cardiac surgery

by Selleckchem | Nov 20 2023

Background: Evaluation of the venous system has long been underestimated as an important component of the circulatory system. As systemic venous pressure increases, the perfusion pressure to the tissues is compromised. During initial resuscitation in cardiac surgery, excessive fluid administration is associated with increased morbidity and mortality.

Methods: We conducted a cross-sectional study of 60 consecutive adult patients who underwent cardiac surgery and in whom it was possible to obtain the venous excess ultrasound (VExUS) grading system and mean systemic filling pressure (Pmsf) in the postoperative period upon admission, at 24 and 48 h. We then determined the correlation between VExUS grading and Pmsf.

Results: On admission, patients with VExUS grading 0 predominated, with a progressive increase in venous congestion and an increase in Pmsf over the course of the first 48 h. There was a strong positive correlation between VExUS grading and the invasive measurement of Pmsf at 24 and 48 h after arrival. The presence of grade 2 or grade 3 venous congestion in the postoperative period poses an increased risk of developing acute kidney injury.

Conclusion: The VExUS grading system indicates a high degree of systemic venous congestion in the first 48 h of the postoperative period after cardiac surgery and correlates with the Pmsf, which is the best surrogate of stressed circulatory volume.

Comments:

The findings from your study highlight the significance of evaluating the venous system in patients undergoing cardiac surgery. The research indicates that systemic venous congestion, as assessed by the VExUS grading system, plays a crucial role in the postoperative period. Here's a breakdown of your study's key points and their implications:

### Key Findings:

1. **Importance of Venous System Evaluation:**
- The venous system's evaluation is crucial and has been historically underestimated in understanding the circulatory system's dynamics, especially in the context of cardiac surgery.

2. **Effect of Venous Congestion:**
- As systemic venous pressure increases, tissue perfusion pressure decreases, potentially compromising perfusion to vital organs and tissues.

3. **Fluid Management in Cardiac Surgery:**
- Excessive fluid administration during initial resuscitation in cardiac surgery is associated with increased morbidity and mortality.

4. **Study Design:**
- Your study involved 60 adult patients who underwent cardiac surgery.
- The VExUS grading system and mean systemic filling pressure (Pmsf) were assessed at different time points: upon admission, at 24 hours, and at 48 hours postoperatively.

5. **Progression of Venous Congestion:**
- Patients with VExUS grading 0 were predominant upon admission.
- Venous congestion increased progressively over the first 48 hours postoperatively.

6. **Correlation Between VExUS and Pmsf:**
- A strong positive correlation was observed between VExUS grading and invasive measurement of Pmsf at 24 and 48 hours after arrival.
- This correlation underscores the relationship between venous congestion and stressed circulatory volume.

7. **Clinical Implications:**
- The presence of grade 2 or grade 3 venous congestion in the postoperative period indicates a higher risk of developing acute kidney injury.
- This suggests that monitoring and managing venous congestion in the early postoperative period is crucial for preventing complications.

### Conclusion and Implications:

- **Significance of VExUS Grading:**
- The study establishes that the VExUS grading system is valuable in assessing systemic venous congestion in the critical early postoperative period after cardiac surgery.

- **Clinical Relevance:**
- Clinicians should be aware of the implications of venous congestion and consider it in the overall management strategy for patients undergoing cardiac surgery.

- **Preventive Measures:**
- Understanding the correlation between venous congestion and stressed circulatory volume can guide clinicians in optimizing fluid management strategies to prevent excessive venous congestion and its associated complications.

- **Further Research:**
- This study sets the stage for further research and clinical trials aimed at refining fluid management protocols and interventions tailored to individual patients' venous dynamics.

In summary, your study underscores the importance of evaluating the venous system, particularly in the context of cardiac surgery, and provides valuable insights into the correlation between venous congestion, systemic filling pressure, and patient outcomes. These findings have the potential to influence clinical practices and improve patient care in the postoperative period after cardiac surgery.