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Purpose The role of diameter and collapse index of inferior vena cava (DCIIVC) in reflecting intravascular volume status and fluid responsiveness remains unclear. We aimed to evaluate the effectiveness of DCIIVC as a clinical indicator for fluid resuscitation (FR) in critically ill hypotensive patients.Methods This retrospective study enrolled hypotensive patients admitted to the surgical intensive care unit (SICU) between May 2018 and April 2019. Between May and October 2018, fluid therapy was conducted by a physician’s decision (non-DCIIVC group, 32 patients). Between November 2018 and April 2019, DCIIVC was used as a guide (DCIIVC group, 30 patients). Clinical outcomes of the two periods were compared.Results Total amount of fluid intake (TAFI) of non-DCIIVC and DCIIVC group in 24 h was 4,130 and 3,560, respectively (p < 0.05). TAFI in 48 h was 8,420 and 6,910, respectively (p < 0.01). Lactate levels at admission, 24 and 48 h after admission were 4.1 vs 3.8, 3.2 vs 3.1, and 1.9 vs 2.1 mmol/L, respectively. Mean duration of mechanical ventilation, ICU stay, and hospital stay were 4.1 vs 4.5, 7.2 vs 6.3, and 18.1 vs 17.2, respectively. Overall mortality was 16.7% vs 13.3%. There was no significant difference in any other characteristic except TAFI.Conclusion DCIIVC can be used as a tool for indicating FR in critically ill hypotensive patients. This can help physicians infuse fluid restrictively, without adverse outcomes.