This single-center prospective randomized controlled trial evaluated the clinical value of the venous volume excess ultrasound score (VExUS) to guide volume management after cardiopulmonary bypass (CPB) surgery. Consecutive adult patients undergoing CPB between January 2024 and October 2025 were randomized 1:1 to a VExUS-guided intervention or to a conventional control strategy. Intergroup comparisons used two-tailed statistical tests with a significance threshold of P < 0.05.
A total of 89 eligible participants completed the trial: 46 patients were assigned to the VExUS-guided group and 43 to the control group. Baseline demographics and intraoperative surgical parameters did not differ significantly between groups (all P > 0.05), indicating balanced randomization for measured covariates.
The trial compared baseline characteristics, intraoperative variables, serial postoperative fluid and transfusion metrics, cumulative net fluid balance, and clinical outcomes including durations of intensive care unit (ICU) stay, mechanical ventilation, and postoperative hospital length of stay. Intergroup comparisons were performed using two-tailed tests and a P value less than 0.05 was considered statistically significant.
At both 12 and 24 hours after surgery, the median albumin transfusion volume was reported as 0 g in both groups. Despite identical medians, the distribution of albumin administration differed: the VExUS-guided cohort demonstrated a broader distribution and a larger proportion of patients receiving high-dose albumin. These between-group differences reached statistical significance at 12 hours (P = 0.007) and at 24 hours (P = 0.015). The abstract reports these differences without providing further breakdown of absolute volumes or thresholds defining high-dose administration; such granular details were not reported in the source.
The cumulative net fluid balance did not achieve statistical significance when compared between groups overall. However, the VExUS-guided cohort showed a more pronounced negative fluid balance trend by 48 hours postoperatively, which the authors interpret as reflecting greater systemic decongestion in the VExUS group. The abstract does not provide exact numeric values for net balance at each time point or the magnitude of the negative trend.
Median postoperative hospital stay was significantly shorter in the VExUS group compared with control: 15 days versus 19 days, respectively (P = 0.027). There were no significant intergroup differences reported for ICU length of stay or total mechanical ventilation time. The abstract does not report on other clinical endpoints such as mortality, specific complications, or readmission rates.
The study received approval from the Ethics Committee of Chenzhou First People’s Hospital (Approval No. 2025069) and was conducted in accordance with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all participants or their legal surrogates. The authors declared no conflicts of interest. The article lists several funding sources associated with regional and institutional grants; those grants are reported in the source but specific financial contributions to the study procedures are not further detailed in the abstract.
The investigators conclude that VExUS-directed volume management optimizes individualized fluid therapy after CPB and is associated with a shorter postoperative hospital stay and an early trend toward greater systemic decongestion at 48 hours. The VExUS-guided approach also corresponded with distinct patterns of albumin use in the first 24 hours postoperatively. Details such as absolute net fluid balance values, definitions of high-dose albumin, mortality, or other complication rates were not provided in the abstract and would require consultation of the full text for complete assessment.
Overall, the trial suggests that ultrasound-assessed venous congestion with the VExUS score may inform postoperative fluid strategy after CPB, producing measurable differences in resource use and early physiologic signs of decongestion. Clinicians interpreting these results should consider that the source provides limited detail in the abstract on several secondary measures; full-text data are needed to appraise effect sizes, safety outcomes, and applicability to diverse surgical populations.