Lung Ultrasound-Guided Fluid Deresuscitation in ICU Patients

This study is testing whether using lung ultrasound to guide fluid removal (de-resuscitation) in ICU patients on mechanical ventilation can improve outcomes. Many critically ill patients receive large amounts of IV fluids during resuscitation; helping the body get rid of excess fluid afterwards may reduce complications like lung congestion and shorten time on the ventilator. You may be eligible if: - You are 18 years or older - You have been admitted to one of the participating ICUs - You are on invasive mechanical ventilation for less than 24 hours at the time of randomization - You are expected to remain on ventilation for more than 24 hours after randomization You may NOT be eligible if: - You are under 18 - You are pregnant - You use long-term home mechanical ventilation - You have a neurological condition likely to prolong ventilation (e.g., Guillain-Barré, ALS, high spinal cord injury, multiple sclerosis, myasthenia gravis) - You have chest wall abnormalities, severe obesity, or pre-existing interstitial lung disease that would interfere with lung ultrasound - You have a condition where targeting a negative fluid balance is dangerous (e.g., subarachnoid bleeding or severe rhabdomyolysis) - You have participated in this RCT before or were transferred from another center after 24+ hours of ventilation Talk to your doctor to see if this trial is right for you.