000			02992nam a22003617a 4500
008			200709s20202020 xxu||||| |||| 00| 0 eng d
022			_a2524-8987
024			_a10.1186/s13089-020-00163-w [doi]
024			_a10.1186/s13089-020-00163-w [pii]
024			_aPMC7142196 [pmc]
040			_aOvid MEDLINE(R)
099			_a32270297
245			_aQuantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system.
251			_aThe Ultrasound Journal. 12(1):16, 2020 Apr 09.
252			_aUltrasound J. 12(1):16, 2020 Apr 09.
253			_aThe ultrasound journal
260			_c2020
260			_fFY2020
265			_sepublish
266			_d2020-07-09
520			_aBACKGROUND: Organ congestion is a mediator of adverse outcomes in critically ill patients. Point-Of-Care ultrasound (POCUS) is widely available and could enable clinicians to detect signs of venous congestion at the bedside. The aim of this study was to develop several grading system prototypes using POCUS and to determine their respective ability to predict acute kidney injury (AKI) after cardiac surgery. This is a post-hoc analysis of a single-center prospective study in 145 patients undergoing cardiac surgery for which repeated daily measurements of hepatic, portal, intra-renal vein Doppler and inferior vena cava (IVC) ultrasound were performed during the first 72 h after surgery. Five prototypes of venous excess ultrasound (VExUS) grading system combining multiple ultrasound markers were developed.
520			_aCONCLUSIONS: The combination of multiple POCUS markers may identify clinically significant venous congestion.
520			_aRESULTS: The association between each score and AKI was assessed using time-dependant Cox models as well as conventional performance measures of diagnostic testing. A total of 706 ultrasound assessments were analyzed. We found that defining severe venous congestion as the presence of severe flow abnormalities in multiple Doppler patterns with a dilated IVC (>= 2 cm) showed the strongest association with the development of subsequent AKI compared with other combinations (HR: 3.69 CI 1.65-8.24 p = 0.001). The association remained significant after adjustment for baseline risk of AKI and vasopressor/inotropic support (HR: 2.82 CI 1.21-6.55 p = 0.02). Furthermore, this severe VExUS grade offered a useful positive likelihood ratio (+LR: 6.37 CI 2.19-18.50) when detected at ICU admission, which outperformed central venous pressure measurements.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aEmergency Medicine
657			_aJournal Article
700			_aSpiegel, Rory
790			_aBeaubien-Souligny W, Bouchard J, Denault AY, Haycock K, Lamarche Y, Rola P, Spiegel R
856			_uhttps://dx.doi.org/10.1186/s13089-020-00163-w _zhttps://dx.doi.org/10.1186/s13089-020-00163-w
942			_cART _dArticle
999			_c5163 _d5163