Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 9, 2021; 10(6): 310-322
Published online Nov 9, 2021. doi: 10.5492/wjccm.v10.i6.310
Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment
Pablo Galindo, Carlos Gasca, Eduardo R Argaiz, Abhilash Koratala
Pablo Galindo, Department of Nephrology, Centro Médico ISSEMYM, Ecatepec 55000, Mexico
Carlos Gasca, Department of Critical Care, Hospital Juárez de México, Mexico City 07760, Mexico
Eduardo R Argaiz, Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Abhilash Koratala, Division of Nephrology, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
Author contributions: Galindo P, Gasca C and Argaiz ER designed and drafted the initial version of the manuscript; Koratala A reviewed and revised the manuscript for important intellectual content; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that no conflicts of interest exist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abhilash Koratala, MD, Assistant Professor, Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226, United States. akoratala@mcw.edu
Received: April 29, 2021
Peer-review started: April 29, 2021
First decision: June 17, 2021
Revised: June 28, 2021
Accepted: September 30, 2021
Article in press: September 30, 2021
Published online: November 9, 2021
Abstract

Accurate assessment of the hemodynamic status is vital for appropriate management of patients with critical illness. As such, there has been a constant quest for reliable and non-invasive bedside tools to assess and monitor circulatory status in order to ensure end-organ perfusion. In the recent past, point of care ultrasonography (POCUS) has emerged as a valuable adjunct to physical examination in various specialties, which basically is a clinician-performed bedside ultrasound to answer focused questions. POCUS allows visualization of the internal anatomy and flow dynamics in real time, guiding apt interventions. While both arterial (forward flow) and venous (organ outflow or afterload) limbs of hemodynamic circuit are important for tissue perfusion, the venous side remains relatively under-explored. With recent data underscoring the deleterious consequences of iatrogenic volume overload, objective evaluation of venous congestion is gaining attention. Bedside Doppler ultrasound serves this purpose and aids in diagnosing and monitoring the congestion/venous blood flow pattern. In this article, we summarize the rationale for integrating this technology into routine care of patients with volume-related disorders, discuss the normal and abnormal waveforms, limitations, and future directions.

Keywords: Ultrasound, Point of care ultrasonography, Doppler, VExUS, Congestion, Hemodynamics, Heart failure, Nephrology, Critical care

Core Tip: Point-of-care Doppler ultrasonography is emerging as a valuable bedside diagnostic tool for the assessment of venous congestion. Doppler interrogation of the abdominal veins such as the hepatic, portal, renal parenchymal veins in addition to inferior vena cava ultrasound provides useful insights into a patient’s hemodynamics, when interpreted in conjunction with other sonographic parameters such as the cardiac pump function, lung ultrasound and conventional clinical assessment.