The Randomized Controlled Trial of Inferior Vena Cava Ultrasound-guided Fluid Management in Septic Shock Resuscitation

Inclusion Criteria: * Patient who attended the emergency department with septic shock (defined by those who require a vasopressor to maintain a mean arterial pressure (MAP) of 65 mm Hg or greater and whose serum lactate level greater than 2 mmol/L in the absence of hypovolemia.) Exclusion Criteria: * 1\) Congestive pulmonary edema or known to have poor systolic cardiac function (left ventricular ejection fraction ≤ 40%). * 2\) Known to have right heart pathologies. * 3\) Having or suspected to have marked ascites, significant bowel dilatation or the conditions that can cause abdominal hypertension. * 4\) Body mass index ≥ 30 kg/square meter. * 5\) Having concomitant attack of severe airway disease (eg. Asthma, COPD) that may have confounded the IVC interpretation due to the positive intrathoracic pressure. * 6\) IVC can not be identified or its diameter cannot be measured correctly. * 7\) Having end-stage renal diseases with or without dialysis. * 8\) Having non-infectious diseases as final diagnoses. * 9\) Pregnant women. * 10\) Have been referred or treated from other healthcare facility. * 11\) Having active hemorrhages. * 12\) Duplicated cases. * 13\) who had "do-not-resuscitate" living will. * 14\) Declined to consent.