Does POCUS-Guided Fluid Management Improve Outcomes in Neurocritical Care? A Retrospective Review

Introduction: Fluid management in neurocritical care is a delicate balance: hypovolemia may cause cerebral ischemia, while fluid overload can lead to pulmonary edema, acute kidney injury (AKI), and prolonged ICU stays. In subarachnoid hemorrhage (SAH), maintaining euvolemia is especially important to reduce vasospasm risk. Although point-of-care ultrasound (POCUS) is increasingly used in critical care, its role in neurocritical care remains underexplored. The Venous Excess Ultrasound Score (VExUS), a targeted POCUS application, offers a novel, non-invasive method to assess venous congestion and guide fluid therapy in this high-risk population.


Methods: We performed a retrospective chart review of 34 adult neurocritical care patients who required fluid resuscitation. Patients were divided into two groups: those managed with daily POCUS assessments during the first three ICU days, and those managed using traditional parameters such as vital signs and physical exam findings. Outcomes included incidence of fluid overload (e.g., pulmonary edema), change in renal function (delta creatinine: day 3 – day 1), and net intake/output over the first three ICU days.


Results: POCUS-guided fluid management resulted in a significantly lower net fluid balance (+473.1±2269.7 vs. –924.6±2725.9 mL, p = 0.04), suggesting more conservative fluid administration. However, POCUS intervention did not significantly reduce pulmonary edema (23.5% vs. 17.4%, p = 0.61) or delta creatinine (+0.19±0.20 vs. –0.03±0.92 mg/dL, p = 0.79).


Conclusions: While POCUS-guided fluid management did not reduce early complications such as pulmonary edema or renal dysfunction, it was associated with a significantly lower net fluid balance. These findings suggest that POCUS may enhance fluid stewardship practices in neurocritical care. Prospective studies are needed to assess whether these benefits impact long-term outcomes.