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Background <p>The paradigm of fluid management in critically ill patients continues to evolve with growing recognition of the detrimental effects of&#xa0;venous congestion and the limitations of static hemodynamic parameters.</p> Objective <p>This perspective examines the complementary roles of Venous Excess Ultrasound Score (VEXUS) and Velocity Time Integral (VTI)&#xa0;measurements in guiding fluid therapy decisions in the intensive care unit (ICU).</p> Key Concepts <p>VEXUS provides critical information about venous congestion while VTI offers insights into cardiac output response to interventions.&#xa0;Together, these ultrasound-based assessments create a more complete picture of a patient's fluid status, enabling clinicians to&#xa0;balance the competing risks of inadequate organ perfusion and harmful venous congestion.</p> Scope <p>This article explores:</p> <p>The physiological basis of VEXUS and VTI integration</p> <p>Practical implementation strategies</p> <p>Emerging evidence supporting the integration of these modalities into ICU practice</p> <p>Application to specific patient populations and clinical scenarios</p> Conclusions <p>We propose a framework for incorporating VEXUS and VTI into a comprehensive hemodynamic assessment strategy that moves&#xa0;beyond the traditional fluid balance approach toward precision fluid management in critical care.</p>

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Integrating VEXUS and VTI for Precision Hemodynamic Management in Critical Care

  • 期刊论文

  • 发表日期：

    2025年8月23日

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  • Shibu Sasidharan

摘要

Background

The paradigm of fluid management in critically ill patients continues to evolve with growing recognition of the detrimental effects of venous congestion and the limitations of static hemodynamic parameters.

Objective

This perspective examines the complementary roles of Venous Excess Ultrasound Score (VEXUS) and Velocity Time Integral (VTI) measurements in guiding fluid therapy decisions in the intensive care unit (ICU).

Key Concepts

VEXUS provides critical information about venous congestion while VTI offers insights into cardiac output response to interventions. Together, these ultrasound-based assessments create a more complete picture of a patient's fluid status, enabling clinicians to balance the competing risks of inadequate organ perfusion and harmful venous congestion.

Scope

This article explores:

The physiological basis of VEXUS and VTI integration

Practical implementation strategies

Emerging evidence supporting the integration of these modalities into ICU practice

Application to specific patient populations and clinical scenarios

Conclusions

We propose a framework for incorporating VEXUS and VTI into a comprehensive hemodynamic assessment strategy that moves beyond the traditional fluid balance approach toward precision fluid management in critical care.