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

Area of Science:

• Critical Care Medicine
• Point-of-Care Ultrasound
• Hemodynamic Monitoring

Background:

• Septic shock management requires careful fluid resuscitation and deresuscitation.
• Venous congestion is a key indicator of fluid overload.
• Point-of-care ultrasound offers a method for real-time assessment.

Purpose of the Study:

• To assess the feasibility of venous excess ultrasound (VExUS)-guided fluid management in adult septic shock patients.
• To determine if VExUS guidance can individualize fluid resuscitation and deresuscitation.
• To evaluate the safety and potential impact on fluid balance.

Main Methods:

• Pilot randomized controlled feasibility trial.
• Adult patients with septic shock randomized to VExUS-guided or usual care.
• Daily VExUS ultrasounds with fluid management recommendations for the intervention arm.

Main Results:

• 19 participants enrolled; 12 randomized to VExUS arm.
• VExUS arm had a lower intervention period fluid balance (-65 mL vs 2608 mL).
• No significant differences in acute kidney injury, respiratory failure, or mortality; rates were lower in VExUS arm.

Conclusions:

• VExUS-guided fluid management is feasible in septic shock.
• The approach was not associated with increased adverse events.
• VExUS guidance may reduce the volume of fluids administered in septic shock.