Impact of Point-of-Care Ultrasound-Guided Resuscitation Protocols in the Treatment of Septic Shock: A Systematic Review of Hemodynamic Outcomes and Mortality

Septic shock is a life-threatening condition requiring rapid hemodynamic stabilization. This review aimed to evaluate the impact of point-of-care ultrasound (POCUS)-guided resuscitation on mortality and hemodynamic outcomes in adults with septic shock. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, PubMed, the Cochrane Library, and Google Scholar were searched up to October 2025 for studies comparing POCUS-guided to conventional resuscitation. Study quality was assessed using the Cochrane Risk of Bias 2.0 and Newcastle-Ottawa scale (NOS) tools. Due to heterogeneity in study designs and outcome measures, a narrative data synthesis was performed, summarizing findings across mortality, hemodynamic, fluid balance, and organ function domains. Fourteen studies met the inclusion criteria, encompassing 11 randomized controlled trials (RCTs) and three cohort studies. Ultrasound-guided resuscitation protocols demonstrated improvements in hemodynamic stability, including higher mean arterial pressure, improved oxygenation indices, and greater lactate clearance compared to standard care. Fluid management outcomes indicated lower total fluid administration and more favorable fluid balance. Several studies reported reductions in organ dysfunction markers, the earlier restoration of perfusion, and the decreased incidence of acute kidney injury (AKI). Additionally, ultrasound-guided protocols were associated with shorter durations of mechanical ventilation and reduced intensive care unit (ICU) and hospital stays. Mortality outcomes showed variable results, with some evidence suggesting a potential survival benefit. Ultrasound-guided resuscitation improves hemodynamic optimization, fluid balance, and organ recovery, offering a more individualized approach to septic shock management.