Background: Sepsis and sepsis shock are leading causes of mortality around the world. Early identification, proper management and close monitoring are associated with improved patient outcomes. Echocardiography allows proper monitoring of fluid-guided therapy and early identification of patients requiring vasopressors and inotropic drugs, although it requires special training and has some limitations. This study aims to compare echocardiography (echo) derived indices to cardiometry-derived indices in management of septic patients. Methods: This prospective, randomized study was carried out on 90 patients with sepsis. The patients were divided into three groups: cardiometry group, which included those who underwent evaluation by the electrical cardiometry monitor; echo group, which included patients who underwent resting transthoracic echocardiography; and early goal-directed therapy (EGDT) group, which included those who received intravenous fluid. Thirty-day mortality was recorded, in addition to total infused fluid, total dose of vasopressor and inotrope, mechanical ventilation (MV) duration, and the intensive care unit (ICU) and hospital stay period. Results: Mortality in echo and cardiometry-guided therapy was significantly lower than in the EGDT group. There was significantly higher norepinephrine and dobutamine doses, prolonged time to weaning of vasopressors, MV, longer ICU and hospital stay duration in echo and cardiometry groups compared to the EGDT group. On the other hand, all measurements were comparable in echo and cardiometry groups. Conclusion: Evidence supports the usefulness of echocardiogram-guided treatment, similar to cardiometry hemodynamic management. However, cardiometry showed the advantage of being a simple and noninvasive technique that does not require a trained cardiologist. Trial registration: Pan African clinical trial registry on 08/05/2019 with unique identification number: PACTR201911842779294.