VESPER
Venous Excess Ultrasound (VEXUS)- Guided Fluid Management vs. Usual Care in Patients with Septic Shock
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PURPOSE
The VESPER pilot randomized controlled trial aims to evaluate whether VEXUS‑guided fluid management—a point‑of‑care ultrasound method for detecting venous congestion—can feasibly be implemented in patients with septic shock. Its core purpose is to determine whether using VEXUS can help clinicians identify early signs of fluid overload and guide more precise fluid administration, with the goal of reducing kidney injury, dialysis requirements, and mortality. The study also examines recruitment feasibility, protocol adherence, and whether this approach leads to improved physiologic outcomes, such as cumulative fluid balance.
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PROGRESS
8
80
patients enrolled
(as of Feb. 2026)
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FUTURE
If the pilot demonstrates feasibility, it will transition into a larger multicenter RCT, designed to definitively test whether VEXUS‑guided fluid management improves clinical outcomes in septic shock. The results may reshape fluid resuscitation practices, resolve long‑standing uncertainty about optimal post‑bolus fluid management, and potentially establish VEXUS as a scalable, non‑invasive tool used across ICUs internationally. The future study aims to provide the high‑quality evidence needed to inform guidelines and transform sepsis care to reduce iatrogenic fluid overload and its related harms.
What is VESPER?
​VESPER is a pilot randomized control trial designed to evaluate whether using the VEXUS method, a POCUS (point-of-care ultrasound technique), can improve fluid management and clinical outcomes in patients with septic shock compared to standard care. ​​The VEXUS method will be used to detect venous congestion, an early marker of fluid overload, by assessing blood flow in central veins (i.e. hepatic, portal, and intra-renal). This approach aims to guide clinicians in making more informed decisions about fluid administration, potentially preventing kidney failure.
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Why is this important?
​VESPER addresses a critical gap in septic shock care: fluid overload, which affects up to 70% of patients and contributes to kidney failure and increased mortality. Current tools for guiding fluid therapy often detect overload after organ injury has occurred.​ Our method offers a non-invasive, early warning system for fluid overload, allowing clinicians to adjust treatment before damage happens. Overall we aim to provide robust evidence that could change how fluids are managed in septic shock, potentially improving survival and reducing complications.
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What is involved in the study?
Patients with septic shock who are enrolled into the study are randomly assigned to one of two groups: standard care or VEXUS-guided fluid management. All patients receive usual treatments for septic shock, including antibiotics, fluids, vasopressors, and monitoring. Those in the VEXUS group undergo daily ultrasound scans for up to three days to assess venous congestion in key veins. Based on the scan results, clinicians adjust fluid therapy- either continuing fluids, restricting them, or actively removing excess fluid using diuretics. This the scans show signs of heart dysfunction, additional treatments such as inotropes or ventilator adjustments may be used. The goal is to personalize fluid management to prevent kidney injury and improve outcomes.
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Study Arms
Intervention Arm:
POCUS team performs VEXUS scan within 6 hours of randomization. Severity of venous congestion is determined based off VEXUS (none, mild, moderate-severe). The level of congestion guides the 24h fluid balance target and management decisions. This is repeated every 24h for 3 days.
