Acute Heart Failure (AHF), Congestion, Congestion, Venous, Fluid Over-load
Conditions
Keywords
Vexus, Venous Excess Ultrasound, Point-of-Care Ultrasound, POCUS, Ultrasound Training, Medical Education, Volume Assessment, Venous Congestion, Duplex Ultrasound, Bedside Ultrasound
Brief summary
This randomized controlled trial evaluates the effectiveness of two training approaches (in-person versus remote) for teaching medical residents to apply the Venous Excess Ultrasound (VExUS) score for bedside volume assessment in patients with acute heart failure. Resident performance will be compared to that of expert physicians certified in abdominal and duplex sonography.
Detailed description
Accurate assessment of volume status is essential in managing acute heart failure but remains challenging in clinical practice. The VExUS score is a validated ultrasound-based tool integrating inferior vena cava diameter and Doppler assessment of hepatic, portal, and intrarenal veins. This single-center randomized controlled trial compares two training modalities (in-person vs. remote) in medical residents with basic ultrasound skills. Participants will be randomized 1:1 to either training method and compared to a control group of expert physicians. Primary outcomes include ultrasound image quality assessed using a standardized 100-point score. Secondary outcomes include time to acquisition, VExUS scoring accuracy, self-confidence, and acceptability of training methods.
Interventions
BEHAVIORALIn-person VExUS Training Program
In-person training consisting of a 1-hour theoretical introduction followed by a 3-hour supervised hands-on ultrasound training session focusing on acquisition and interpretation of the VExUS score.
BEHAVIORALRemote VExUS Training Program
Remote training consisting of an e-learning module followed by independently performed ultrasound examinations with asynchronous expert feedback (via phone or email).
OTHERNo intervention
SGUM-certified physicians performing VExUS examinations as expert reference standard.
Sponsors
Insel Gruppe AG, University Hospital Bern
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Medical residents in general internal medicine * Basic ultrasound skills (POCUS component 1 or ≥200 scans) * Working at study site during study period
Exclusion criteria
* SGUM certification in abdominal ultrasound * Advanced duplex ultrasound experience * Prior vascular/duplex training
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ultrasound Image Quality Score | From training until 6 months after completion of training | The primary outcome will be a quality score, adapted from a quality score used in a previous randomized controlled trial which investigated a simulator-based training program for transoesophageal echocardiography.11 The quality score will include items commonly used for assessment of ultrasound quality: angle and depth, overall clarity, visualization of the anatomical structures, focus, doppler gain, scale and baseline resulting in a maximum achievable quality score of 100 points. If multiple images of the predefined views are captured, each image will be rated, and the best rating will be kept to calculate the final score. If a view is missing, 0 point will be awarded for that view. All ultrasound images will be independently assessed by experts for abdominal sonography and use Doppler sonography in their daily clinical practice and are blinded to the role (resident vs. SGUM-certified physician) and training (in-person vs. remote) program of the participants. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time for Image Acquisition and Interpretation | From training until 6 months after completion of training | Time required by participants to perform the ultrasound examination and interpret the images during VExUS assessment |
| Change in self-confidence in performing VExUS assessment | From baseline (before training) to immediately after completion of training | Self-reported confidence measured using a Likert-scale questionnaire before and after training |
| Acceptability of the program (quantitative assessment) | Immediately after completion of training and during the outcome assessment period (within 2 months after training) | Acceptability of the program will be assessed using a structured survey with 5-point Likert scale items based on an implementation framework (e.g., Theoretical Domains Framework). Results will be reported as mean scores or median values on a 5-point scale, where higher scores indicate greater acceptability. |
| VEXUS score | From training until 6 months after completion of training | The Venous Excess Ultrasound Score (VExUS) is a semi-quantitative ultrasound-based score used to assess systemic venous congestion by combining inferior vena cava (IVC) diameter and Doppler flow patterns of abdominal veins, including hepatic, portal, and intrarenal veins. The score ranges from 0 to 3, with 0 indicating no congestion, 1 indicating mild congestion, 2 indicating moderate congestion, and 3 indicating severe venous congestion. Higher scores indicate greater venous congestion and worse clinical status. |
| Acceptability of the program (qualitative assessment) | Immediately after completion of training and during the outcome assessment period (within 2 months after training) | Acceptability, including perceived barriers and facilitators to implementation, will be explored through semi-structured interviews. Data will be analyzed using thematic analysis guided by an implementation framework. |
Countries
Switzerland
Contacts
CONTACTCaroline Rimensberger, MD
CONTACTClaudio Schneider, MD
Outcome results
None listed