Venous excess ultrasound (VExUS) scoring in mechanically ventilated children: an evaluation of feasibility
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Supporting information
Accepted version
Author(s)
Wadia, Toranj
Varghese Baby, MAnuel
Ghazaly, Marwa
Padmanabhan, Ramnarayan
Type
Journal Article
Abstract
Background: Congestion in ventilated, critically ill children may arise from disease pathology or from interventions (fluid resuscitation, positive-pressure ventilation, and vasoactive agents). We assessed the feasibility of applying adult VExUS scoring profiles (with and without IVC diameter) in this population and the inter-rater reliability of stored-image interpretation. Secondary objectives were to explore congestion patterns across diagnostic groups and variation with critical care interventions.
Methods: Children admitted to St Mary's Hospital PICU (4 February–7 April 2025) were scanned at 24 hours post-intubation, every 48 hours, and 24 hours post-extubation. Inter-rater reliability was assessed using Cohen's kappa. Diagnosis, interventions, and fluid balance were correlated with VExUS scores.
Results: VExUS profile D (excluding IVC diameter) was feasible in the greatest number of patients. Forty-nine scans from 22 patients (median age 15 months; 46% female) were included. Inter-rater reliability was high (κ=0.82, 95% CI 0.59–1.00). Median VExUS score
fell from 2 (IQR 1–3) post-intubation to 1 (IQR 1–1) post-extubation (V=41.5, p=0.023, r=0.84). Cumulative fluid balance at 24 hours differed significantly across VExUS grades (p=0.026, ε²=0.279): a score of 2 was associated with more negative percentage fluid balance
(–0.55%, IQR –2.41 to 0.47) than a score of 1 (1.30%, IQR 0.33–2.61; adjusted p=0.037).
Conclusion: VExUS profile D was the most feasible scoring approach in critically ill children, with good inter-rater reliability for stored-image interpretation, supporting remote mentorship where junior staff acquire images for expert review. The consistent fall in scores following
extubation suggests positive-pressure ventilation may confound scoring.
Methods: Children admitted to St Mary's Hospital PICU (4 February–7 April 2025) were scanned at 24 hours post-intubation, every 48 hours, and 24 hours post-extubation. Inter-rater reliability was assessed using Cohen's kappa. Diagnosis, interventions, and fluid balance were correlated with VExUS scores.
Results: VExUS profile D (excluding IVC diameter) was feasible in the greatest number of patients. Forty-nine scans from 22 patients (median age 15 months; 46% female) were included. Inter-rater reliability was high (κ=0.82, 95% CI 0.59–1.00). Median VExUS score
fell from 2 (IQR 1–3) post-intubation to 1 (IQR 1–1) post-extubation (V=41.5, p=0.023, r=0.84). Cumulative fluid balance at 24 hours differed significantly across VExUS grades (p=0.026, ε²=0.279): a score of 2 was associated with more negative percentage fluid balance
(–0.55%, IQR –2.41 to 0.47) than a score of 1 (1.30%, IQR 0.33–2.61; adjusted p=0.037).
Conclusion: VExUS profile D was the most feasible scoring approach in critically ill children, with good inter-rater reliability for stored-image interpretation, supporting remote mentorship where junior staff acquire images for expert review. The consistent fall in scores following
extubation suggests positive-pressure ventilation may confound scoring.
Date Acceptance
2026-07-18
Citation
The Ultrasound Journal
ISSN
2524-8987
Publisher
SpringerOpen
Journal / Book Title
The Ultrasound Journal
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
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Publication Status
Accepted