Table 6.

Evidence profile for principal POCUS applications in adult ED sepsis and septic shock.

Application	Evidence profile	Main supporting studies	Current clinical role
Lung and pleural ultrasound	Moderate diagnostic evidence; adult pneumonia meta-analysis and diagnostic studies; direct outcome evidence remains limited.	Reviews and representative studies (8, 12, 15, 17–20)	Support a clinically concordant respiratory source, identify pleural complications, or reveal competing pulmonary physiology; do not replace CT/formal imaging when uncertainty persists.
Biliary, renal/bladder, and soft-tissue POCUS	Moderate rule-in diagnostic evidence for selected targets; heterogeneous indications and little evidence for patient-centered outcome benefit.	Systematic reviews and observational studies (21–25)	Trigger formal imaging, drainage planning, urologic/biliary decompression, surgical consultation, or source-control escalation in clinically selected patients.
FoCUS shock phenotyping	Supportive physiologic and diagnostic evidence; ED shock trials are not sepsis-specific and have not shown consistent short-term outcome improvement.	ED shock trials and focused reviews (29, 30, 32–34)	Identify major ventricular dysfunction, RV loading, pericardial disease, or a vasoplegic-dominant pattern as context for reassessment and escalation.
PLR with LVOT VTI or aortic flow surrogate	Moderate physiologic evidence for fluid responsiveness; heterogeneous modalities and limited direct ED sepsis outcome evidence.	Physiologic reviews and systematic synthesis (31, 34–36)	Estimate whether stroke volume is likely to rise; responsiveness alone is not an indication to administer fluid.
Serial LUS congestion assessment	Supportive physiologic and observational evidence; findings are nonspecific and treatment-outcome evidence is limited.	Consensus, physiologic, and review evidence (8, 19, 20, 31)	Track pulmonary interstitial burden and fluid tolerance alongside perfusion need, baseline lung disease, and ventilator effects.
Venous Doppler/VExUS	Emerging, predominantly observational and ICU-based evidence; ED sepsis data, interobserver reliability, and treatment validation remain limited.	Development, conceptual, and pilot cohort studies (37–39)	Optional advanced assessment in selected patients with adequate expertise and image quality; not a routine ED sepsis requirement.

Evidence categories are qualitative and reflect study design, consistency, ED specificity, and directness to the bedside question; they are not formal GRADE ratings. CT, computed tomography; ED, emergency department; FoCUS, focused cardiac ultrasound; GRADE, Grading of Recommendations Assessment, Development and Evaluation; ICU, intensive care unit; LUS, lung ultrasound; LVOT, left ventricular outflow tract; PLR, passive leg raise; POCUS, point-of-care ultrasound; RV, right ventricle/right ventricular; VExUS, venous excess ultrasound; VTI, velocity-time integral.