Critical Care Ultrasound-Guided Targeted Volume Management as Precision Medicine: Predicting Clinical and Financial Impacts

Precision medicine in the intensive care unit (ICU) is increasingly defined by individualized, bedside physiologic assessment rather than protocolized treatment algorithms. Critical care ultrasound for targeted volume management (CCUS-TVM) operationalizes this shift by helping clinicians answer two questions before administering intravenous (IV) fluids: is it safe, and will it be effective? Static measures, such as inferior vena cava (IVC) assessment and the Venous Excess Ultrasound Score (VExUS), identify venous congestion and predict fluid intolerance, while dynamic measures, such as change in left ventricular outflow tract velocity time integral or carotid flow time after passive leg raise, predict volume responsiveness. Together, these tools allow clinicians to tailor resuscitation to an individual patient’s underlying hemodynamics, complementing the four-interface model of shock physiology. Recent meta-analyses and the 2024 Society and Critical Care Medicine and 2026 Surviving Sepsis Campaign guidelines show that CCUS-TVM—particularly dynamic assessment—contributes to fewer episodes of renal replacement therapy and mechanical ventilation, shorter ICU stays, and decreased mortality. Beyond clinical benefit, this communication presents an original, exploratory estimate of the potential per-patient cost savings associated with dynamic CCUS-TVM in sepsis— approximately $2600–4400—driven by reductions in renal replacement therapy, mechanical ventilation, and ICU length of stay. Taken together, CCUS-TVM offers a clinically validated and economically favorable framework for advancing precision medicine in resuscitation.