VExUS scoring for cardiorenal and critical-care POCUS. One IVC measurement, three Doppler signals — one grade, zero ambiguity. Built on the published grading algorithm and running right here on the page.
Enter the four values the way you would at the bedside and the grade updates as you go: IVC diameter gates the score, then the three Doppler patterns set the grade. Free, no signup.
Educational scoring tool. Not a diagnostic device and not a substitute for clinical judgement. Doppler waveforms are stylised for illustration.
VExUS reads pulsed-wave Doppler from three venous beds, after confirming a dilated IVC. Here is where to place the sample gate and what a normal trace looks like in each.
Subcostal or right-intercostal view, sample gate on a hepatic vein just before it joins the IVC. Normal flow is antegrade with the systolic (S) wave equal to or larger than the diastolic (D) wave.
At the porta hepatis, sample the main portal vein. Normal flow is nearly continuous. Pulsatility fraction = (Vmax − Vmin) / Vmax; under 30% is normal.
Colour Doppler over the renal parenchyma, then pulsed-wave on an interlobar vein. Normal intrarenal venous flow is continuous throughout the cardiac cycle.
A dilated IVC (≥ 2 cm) opens the score. The grade is then set by how many of the three veins show a severe pattern — mild patterns do not raise the grade beyond 1.
| Sign | Normal | Mild | Severe |
|---|---|---|---|
| IVC diameter | < 2 cm | ≥ 2 cm — dilated, opens grading | |
| Hepatic vein | S ≥ D | S < D (blunted) | Systolic reversal |
| Portal vein | Pulsatility < 30% | 30–49% | ≥ 50% |
| Intrarenal vein | Continuous | Biphasic (S + D) | Monophasic (D only) |
VExUS answers a question fluid management has always struggled with: is the venous side congested, and how badly? It gives a repeatable 0–3 signal at the bedside, used across nephrology, cardiology, critical care and the perioperative setting.
Grading congestion on the kidney–heart axis — the fluid overload a blood pressure never shows — where it helps inform whether to keep decongesting.
A repeatable signal to follow fluid removal and track response over hours to days, rather than relying on weight and gestalt alone.
The protocol was first derived to predict acute kidney injury after cardiac surgery, and is now applied more broadly in critical-care fluid assessment.
The grading system was published in 2020 and has since been cited in over 500 papers across critical care, nephrology and cardiology. The key references:
Start with the plain-language primer — what point-of-care ultrasound is, what the VExUS score measures, and how the grade is built, step by step.