Open Access 29-01-2025 | Diuretics | Correspondence
Expanding the role of PoCUS in tailoring diuretic strategies for congestion management in critical care
Published in: Intensive Care Medicine
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Ostermann et al. recently highlighted the role of diuretics in managing fluid overload (FO) in critically ill patients [1]. Their discussion underscores the association between FO and increased morbidity and mortality, partly due to its detrimental effects on organ function. In particular, the impact of FO on kidney function has become increasingly recognized. This condition, termed congestive nephropathy (Fig. 1), refers to the retrograde transmission of elevated central venous pressure (CVP) to venous territories caused by increased right ventricular filling pressures [2]. The authors highlight the utility of Doppler-based scores, such as the Venous Excess Ultrasound (VExUS) grading system, in phenotyping venous congestion [1]. While VExUS provides valuable insights, multi-organ point-of-care ultrasonography (PoCUS) offers a broader perspective by enabling comprehensive hemodynamic assessment. PoCUS facilitates the evaluation of pulmonary tissue congestion and pleural effusion through lung ultrasound. Additionally, it allows for a qualitative assessment of cardiac morphology and function. Advanced users can estimate left and right ventricular filling pressures using pulsed-wave Doppler and tissue Doppler imaging. Since VExUS is not specific to FO, simultaneous cardiac imaging is essential [3]. Compared to traditional tools, PoCUS provides real-time, actionable bedside data, enhances decision-making in FO management, and does not involve radiation exposure.
Fig. 1
Key diagnostic components of congestive nephropathy. PoCUS Point-of-care Ultrasonography, IRVF Intrarenal Venous Flow
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