Clinical value of the venous volume excess ultrasound score (VExUS) for volume management following cardiopulmonary bypass (CPB).

OBJECTIVE: To assess the clinical value of VExUS-guided volume management in patients following CPB surgery. METHODS: A single-center, prospective, randomized controlled trial was performed. All adult patients undergoing CPB surgery between January 2024 and October 2025 were consecutively enrolled and randomly allocated in a 1:1 ratio to either a VExUS-guided intervention group or a conventional control group. Baseline demographics, intraoperative surgical parameters, serial postoperative fluid and transfusion metrics, and clinical outcomes were compared between the two cohorts. Intergroup comparisons were conducted using two-tailed statistical tests, with a significance level of P < 0.05. RESULTS: A total of 89 eligible participants completed the study, including 46 in the VExUS group and 43 in the control group. Baseline clinical profiles and all intraoperative variables showed no statistically significant intergroup differences (all P > 0.05). At 12 h and 24 h postoperatively, the median albumin transfusion volume was 0 g in both groups; however, the VExUS-guided cohort exhibited broader data distribution and a larger proportion of patients receiving high-dose albumin administration, with significant between-group differences (P = 0.007 and P = 0.015, respectively). The median postoperative hospital stay was markedly shorter in the VExUS group (15 days vs. 19 days, P = 0.027). No significant differences were observed in intensive care unit (ICU) or total mechanical ventilation time. Although the cumulative net fluid balance did not reach statistical significance between groups, the VExUS-guided group demonstrated a more prominent negative fluid balance trend at 48 h postoperatively, reflecting greater systemic decongestion. CONCLUSION: VExUS-directed volume management optimizes personalized fluid therapy and shortens postoperative hospital stay in patients undergoing CPB surgery.