Deresuscitation Informed by Ultrasound in Patients with Septic Shock Trial: A Pilot Randomized Controlled Study

Document Type

Article

Publication Date

3-10-2026

Institution/Department

Emergency Medicine

Journal Title

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

Abstract

OBJECTIVES: The venous excess ultrasound (VExUS) can be used at the point-of-care to identify venous overload and end-organ congestion in an effort to individually tailor resuscitation and deresuscitation in patients with septic shock. METHODS: We conducted a pilot randomized controlled feasibility trial of VExUS-guided fluid management in adult patients with septic shock. Participants were randomized to VExUS-guided fluid management or usual care. Daily ultrasounds were performed on all participants; in the VExUS-guided study arm, the clinical care team was informed of the VExUS results and given a fluid management recommendation (the intervention). RESULTS: We enrolled 19 participants; 12 (63%) were randomized to the VExUS arm. The intervention period fluid balance was -65 mL (interquartile range [IQR] -1733 to 2016) in the VExUS arm compared to 2608 mL (IQR -435 to 4460) in the usual care arm (p = .21). The secondary outcomes of acute kidney injury, respiratory failure, hospital, and 30-day mortality did not differ significantly between the 2 arms; although the rates were lower in the VExUS arm. CONCLUSIONS: We demonstrate that VExUS-guided fluid management in patients with septic shock is feasible, was not associated with an increased risk of adverse events, and may reduce the volume of fluids administered.

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