A 37-year-old woman with a medical history of type 1 diabetes mellitus, systemic hypertension, and chronic kidney disease due to glomerulosclerosis was admitted with multifocal pneumonia and empyema. She underwent a small-bore tube thoracostomy placement and rapidly developed respiratory failure and shock. She was intubated and started on norepinephrine. Table 1 is a summary of the daily urine output (UOP), fluid balance per day, and corresponding serum creatinine level during the initial ICU stay. Mechanical ventilator settings were as follow: pressure-regulated volume control; tidal volume, 450 mL; respiratory rate, 20 breaths/min; positive end-expiratory pressure (PEEP), 8 cm H2O; and Fio2, 50%. Urinary sediment was positive with granular casts. The calculated plateau pressure (PP) was 32 cm H2O. On day 4, consultation requested a point-of-care echocardiography (POCE) to be performed. Video 1A shows the subcostal longitudinal view of the inferior vena cava (IVC), and Figure 1 shows the corresponding M mode of the IVC. Figure 2 shows an apical 5C view of the pulse-wave Doppler of the left ventricular (LV) outflow tract (LVOT) and Video 1B, an apical 4C view. Video 1C shows the lung ultrasound (abnormal lung finding seen diffusely). Pulse-wave Doppler of the mitral inflow showed an impaired relaxation pattern with E to A wave reversal. Calculated E/e′ was < 8 (not shown).