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Open Access 29-01-2025 | Diuretics | Correspondence

Expanding the role of PoCUS in tailoring diuretic strategies for congestion management in critical care

Authors: Gregorio Romero-González, Abhilash Koratala, Jordi Soler-Majoral, Amir Kazory, Claudio Ronco

Published in: Intensive Care Medicine

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Excerpt

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.
Literature
Metadata
Title
Expanding the role of PoCUS in tailoring diuretic strategies for congestion management in critical care
Authors
Gregorio Romero-González
Abhilash Koratala
Jordi Soler-Majoral
Amir Kazory
Claudio Ronco
Publication date
29-01-2025
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-025-07801-8