Is it all about the right? Echocardiographic metrics of right-sided venous congestion are frequent in trauma patients with hemorrhagic shock.

Abstract

Detecting right-sided venous congestion (RSVC) is more difficult than left-sided venous congestion (LSVC). Point-of-care ultrasound (POCUS) can assess venous Doppler flow patterns in the hepatic (HV), portal (PV), and renal (RV) veins. RSVC can predict organ injury from volume overload in critically ill patients. The prevalence and feasibility of measuring RSVC are unknown in traumatic hemorrhagic shock (THS). This is a retrospective review of quality improvement data regarding feasibility and utility of assessing RSVC in THS. All trauma patients who were transfused, had at least one systolic blood pressure measurement <90 mmHg, and/or a heart rate >108 beats per minute, and/or lactate >2.0 mmol/L within one hour of admission were flagged. Sonographic examinations were performed within 48 hours. RSVC included PV >30% pulsatility, HV systolic<diastolic, RV pulsatility. LSVC included B-lines. Statistical significance was assessed with χ2 and Fischer exact tests. Of 182 patients screened, 135 met inclusion criteria. Ninety-six examinations were performed. Seventy-eight percent were male with mean age of 48.3 years. Forty-seven percent were African American and 42% Caucasian. Seventy percent sustained blunt injury. Median injury severity score on admission was 24. Venous congestion was assessed in 94.7% of patients; PV in 81.3%, HV in 79.1%, and RV in 51%. Thirty-seven percent had at least one metric of RSVC. Conversely, LSVC was present in only 4.2% of patients, P<0.001. Patients with an abnormal TAPSE (≤1.7 cm) have an OR of RSVC of 4.24 (CI: 1.17-13.73, P=0.046). Evidence of RSVC is prevalent in patients with THS, significantly more than LSVC at 24 hours. This could be an unintended consequence of life-saving massive transfusion and cardiac dysfunction and may identify a cohort of patients that would benefit from a fluid-restricted approach to resuscitation. Further studies are needed for validation and to better understand the etiology and clinical relevance of RSVC in THS. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.). Level IV.