What is the assessment of Vexus (intravenous) fluid?

From the Guidelines

Vexus fluid assessment should be performed using a phased array or curvilinear probe to visualize the IVC, internal jugular veins, and hepatic veins, and guided by the most recent evidence on fluid management, such as the Surviving Sepsis Campaign guidelines 1. To perform this assessment, use a phased array or curvilinear probe to visualize the IVC in the subxiphoid view, measuring its diameter and collapsibility during respiration.

Key Components of Vexus Fluid Assessment

• Normal IVC diameter ranges from 1.5-2.5 cm with less than 50% collapsibility suggesting fluid overload, while a small, collapsible IVC indicates hypovolemia.
• Assess the internal jugular veins for distention and hepatic veins for pulsatility.
• This three-point assessment provides a more accurate picture of volume status than any single measurement alone. The VEXUS approach is particularly valuable in critically ill patients where traditional vital signs may be misleading due to compensatory mechanisms or medication effects.

Fluid Management Considerations

• Initial fluid resuscitation should begin with 30 mL/kg of crystalloid within the first 3 hours, as recommended by the Surviving Sepsis Campaign guidelines 1.
• Further fluid management should be guided by functional hemodynamic measurements, such as echocardiography and dynamic measures of assessing fluid responsiveness.
• The use of CVP alone to guide fluid resuscitation can no longer be justified, and dynamic measures such as pulse pressure variation should be used to predict fluid responsiveness 1. This ultrasound-based method allows for real-time, non-invasive assessment that can guide fluid management decisions, helping to prevent complications of both under-resuscitation and fluid overload in clinical settings.

Clinical Application

• The VEXUS approach can be used in conjunction with other fluid management strategies, such as the use of vasopressors and inotropes, to optimize patient outcomes.
• The assessment should be performed by a trained healthcare professional, and the results should be interpreted in the context of the patient's overall clinical condition. By using the VEXUS approach and following the most recent evidence-based guidelines, healthcare professionals can optimize fluid management and improve patient outcomes in critically ill patients.

From the Research

Vexus Fluid Assessment

• The assessment of fluid status is crucial in critically ill patients, as it can lead to different clinical pathways for management 2.
• Fluid therapy is a leading management strategy for patients with hypovolemic and distributive shock, but inadequate or excessive fluid use can lead to complications, including organ failure and mortality 2, 3.
• Intensivists use various tools to monitor hemodynamic status, including medical history, physical examination, and specific hemodynamic monitoring devices, to promote adequate fluid resuscitation 2.
• The use of central venous pressure (CVP) to guide fluid administration has been questioned, as it is not a reliable parameter of volume status or fluid responsiveness 3, 4.
• Conservative fluid strategies have been associated with lower mortality in trauma patients, and the use of smaller volumes to perform fluid challenges, monitoring of extravascular lung water, and earlier use of norepinephrine can help reduce morbidity and mortality from severe sepsis 3.
• Crystalloids are recommended for fluid resuscitation in sepsis/shock, but the choice between crystalloids and colloids depends on the patient's condition and the underlying cause of shock 5.
• Maintaining the balance of fluid and electrolytes is crucial to patient care, and practitioners must be aware of key monitoring and assessment parameters, including key electrolytes, their function, normal values, signs and symptoms of imbalances, and treatment modalities 6.