POINT-OF-CARE ULTRASOUND (POCUS) IN THE INITIAL MANAGEMENT OF REFRACTORY SEPTIC SHOCK: AN INTEGRATIVE REVIEW
Keywords:
Point-of-Care Ultrasonography, Septic Shock, Fluid Resuscitation, Echocardiography, Venous CongestionAbstract
Point-of-care ultrasonography (POCUS) has become an essential tool in the care of critically ill patients, enabling rapid, dynamic, and repeatable hemodynamic assessment. In refractory septic shock, where persistent hypotension and hypoperfusion impose therapeutic challenges, POCUS has proven particularly useful to integrate parameters of responsiveness, tolerance, and congestion, supporting individualized decisions on fluids and vasopressors. This study is an integrative review of the literature, exploratory and descriptive in nature, developed through searches in the PubMed, Scopus, Web of Science, SciELO, and Cochrane Library databases, covering the period from 2010 to 2025. A total of 47 articles were included, comprising systematic reviews, clinical trials, cohort studies, and international guidelines, selected according to relevance and methodological quality. The results demonstrated that passive leg raising (PLR) combined with LVOT-VTI is the most robust strategy for predicting fluid responsiveness. Lung ultrasound (LUS) stood out in the identification of hemodynamic intolerance, while the venous excess ultrasound (VExUS) score emerged as a promising tool to estimate the risk of fluid overload and acute kidney injury. Structured protocols such as RUSH and SIMPLE showed increased diagnostic accuracy of shock phenotypes and favored the multimodal application of POCUS. It is concluded that POCUS represents a transformative milestone in the management of refractory septic shock, as it enables personalized, safe, and real-time approaches. However, gaps remain regarding its impact on hard clinical outcomes, highlighting the need for multicenter trials and methodological standardization to consolidate its incorporation as a standard of care.
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Copyright (c) 2025 Jaime Javier Garcia Caro, Miriani Perin, Rui Alves Pinto de Sá, Lídia Assis Chaves, Jessica Fabini Escobar, Daniel Gomes Fialho, Antônio Felipe Acúrcio Valle dos Santos, João Pedro Duarte de Andrade, Victor Maia Vieira, Dário Rodrigo Salvador de Lima, Luis Fernando de Freitas Reis, Otávio de Meireles Delfino, Mario Gabriel Costa Ramos, Gabriella Salomão de Paula, Marcela Marinho de Oliveira, Lucas da Cruz Alarcon Lima, Antonio Lucas Nunes de Oliveira, Thiago Vinicius Dorneles Bezerra, Giovanna Sarturi, Gregório Dantas dos Santos, Brenda Mendes Souza
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
