Recombinant Human Brain Natriuretic Peptide for the Recovery Stage of Septic Shock

Inclusion criteria: 1. Age \>18 years. 2. Septic shock in recovery phase with decreasing vasopressor requirements, which is defined as: 1. Fulfilling the Sepsis-3 definition of septic shock at initial stage. 2. Hemodynamic stability achieved after adequate initial resuscitation and individualized hemodynamic optimization. 3. Controlled infection source with 48-hour trend of improving temperature, white blood cell count, and procalcitonin. 4. 48-hour trend of decreasing vasopressor requirements and transition to negative fluid balance. 5. Adequate perfusion with warm extremities, and capillary refill time \<3 seconds. 3. Ongoing pulse index continuous cardiac output (PiCCO) hemodynamic monitoring and sinus rhythm. 4. Volume indicators above the lower limit of normal range, with global end-diastolic volume index (GEDI) \>680 mL/m2 and central venous pressure (CVP) \>8 mmHg. 5. Signs of cardiac dysfunction: BNP\>200\[10\] or NT-proBNP \>900 pg/ml\[6\] or reduced ejection fraction (LVEF) \< 50%. 6. No bolus dose of diuretics had been administered in the previous 6 hours. 7. Informed consent obtained from patient/legal representative. Exclusion Criteria: 1. Pregnancy or lactation. 2. Arrhythmia. 3. Advanced renal dysfunction (Acute Kidney Injury \[AKI\] stage 3 or Chronic Kidney Disease \[CKD\] stage 3b or higher) based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. 4. Inadequate ultrasound window preventing acquisition of diagnostic-quality images. 5. Trauma or neurological diseases (including intracerebral hemorrhage and cerebral infarction). 6. Pre-existing severe heart failure (New York Heart Association \[NYHA\] class III-IV) or acute myocardial infarction within the past 30 days. 7. Concurrent enrollment in interventional trials that could confound study outcomes. Criteria for withdrawing from the study: 1. Withdrawal of the informed consent. 2. Severe hemodynamic deterioration necessitating the discontinuation of all vasodilatory medications. 3. Treating clinician's decision.