A comparison of intraoperative VExUS score with central venous pressure and pulse pressure variation in guiding fluid management in patients undergoing valvular cardiac surgery: an interventional study

Intraoperative fluid administration is a crucial element of anaesthesia management. While fluids may have beneficial effect, excessive fluid administration can lead to fluid buildup, which has been linked to negative side effects and subpar clinical results. Longer mechanical ventilation, renal failure, and possibly death are linked to fluid overload.[1,2]. Fluid buildup is a significant risk factor for extending mechanical ventilation, according to a 2020 prospective observational analysis by Da Silva SC et al. that included 496 patients undergoing coronary artery bypass graft (CABG).[3]Acute kidney injury (AKI) and positive fluid balance are correlated in patients undergoing general cardiac surgery; patients with zero fluid balance have the lowest risk of AKI. [4] In a multicenter randomized controlled research involving 171 patients, a statistically significant association was discovered between the use of diuretics and early ventilator weaning.[5] Therefore, especially in heart surgery, having zero or negative fluid balance before to extubation is essential.

Fast-track treatment in cardiac surgery refers to the use of anesthetic medicines that allow patients having cardiac surgery to discontinue mechanical ventilation quickly in the postoperative period.[6,7]According to current statistics, the earliest and safest time for fast tracking in cardiac surgery patients was within three hours after surgery.[8]Studies suggest that fast-track cardiac surgical management leads to better patient outcomes, shorter hospitalizations in the intensive care unit (ICU), shorter hospital stays, and lower health-care costs. Furthermore, several studies have found that the fast tracking does not increase the incidence of postoperative complications, death, or reintubation rates.

The Venous Excess Ultrasound Score (VExUS), a minimally invasive indicator of venous congestion, has gained popularity since its launch in 2020. By analyzing the inferior vena cava and hepatic and portal vein Doppler flow indices, the VExUS score assesses systemic congestion. This modality has a number of expanding and promising uses.

However, there are no reports of complete VExUS evaluations using transesophageal echocardiography (TEE), a technique frequently employed in cardiac surgery patients.

Consequently, the current study will look into how the VExUS score affects patients having single valve replacement surgeries in terms of fluid management.