ABC Imagem Cardiovasc. 2026; 39(1): e20260012
My Approach to VExUS Assessment Using Transesophageal Echocardiography: A Step-by-Step Performance Guide
DOI: 10.36660/abcimg.20260012i
ABSTRACT
Monitoring systemic venous congestion has become essential in the management of critically ill patients, enabling accurate diagnosis, severity grading, and prognostic stratification. Literature shows that congestion is strongly associated with the development of acute kidney injury and increased mortality when compared with optimized volume states.
In this setting, intraoperative Transesophageal Echocardiography (TEE) has emerged as an advanced and versatile tool. In addition to allowing detailed assessment of cardiac function, TEE is effective in assessing intravascular volume status and predicting fluid responsiveness through dynamic measurement of stroke volume and the degree of systemic congestion. TEE also enables direct visualization of abdominal vessels, such as the hepatic, portal, and intrarenal veins, thereby facilitating the identification of pathological pulsatile flow patterns even in patients with limited transthoracic acoustic windows.
The integration of protocols such as VExUS (or its modified version, mVExUS) allows for a personalized approach focused on “perfusion without congestion.” This review outlines the practical application of VExUS assessment using TEE, its technical limitations, and how to use it to guide hemodynamic resuscitation, minimizing organ injury and optimizing clinical outcomes.
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