Table 2.

FoCUS phenotypes in sepsis: bedside patterns and potential ED reassessment pivots.

Phenotype pattern	Suggestive ultrasound features	Clinical implication	Typical ED management pivot
Vasodilatory-dominant after the initial fluid step	Hyperdynamic or preserved LV function, no major RV strain, minimal congestion	Persistent hypotension may be more vasoplegic than preload-responsive	Supports consideration of earlier norepinephrine over further empiric fluid when dynamic testing and congestion assessment remain unfavorable
LV systolic dysfunction/septic cardiomyopathy	Depressed LV systolic function, often with pulmonary congestion on LUS	Higher risk of fluid intolerance; perfusion may not improve with repeated boluses	Supports consideration of vasopressor support and selected inotropic evaluation; avoid assuming further empiric fluid will improve perfusion
RV strain or RV loading	RV dilation and/or septal flattening, often with severe hypoxemia	Consider pulmonary embolism, pulmonary vascular load, or ARDS-related RV dysfunction	Supports broader evaluation of myocardial dysfunction and congestion rather than assuming further fluid is beneficial by default
Obstructive or coexisting nonvasoplegic process	Pericardial effusion/tamponade physiology or marked obstructive RV pattern	Potential alternative or coexisting obstructive process	Supports urgent cause-directed escalation over a default sepsis-only framing

ARDS, acute respiratory distress syndrome; ED, emergency department; FoCUS, focused cardiac ultrasound; LUS, lung ultrasound; LV, left ventricle/left ventricular; RV, right ventricle/right ventricular.