Table 2.

Studies examining the utility of POCUS in identifying the source of sepsis, as well as guiding and managing septic patients *.

1st Author, Year, Country, Design, Setting	POCUS Protocol (If Any)	Aim	Patient Number/Age and Main Inclusion Criteria	Main Results
Cortellaro et al., 2017, Italy, POS, single-center ED [18]		Comparison of standard diagnostic work-up vs. early POCUS use regarding speed of diagnosis and accuracy in identification of the infectious source	200/>18 yo	Post-POCUS identification of sepsis cause: sensitivity 73%, accuracy 75%. All post-POCUS diagnoses obtained within 10 min Source-related sensitivity post-POCUS: pneumonia > 90%, soft tissue infection and cholecystitis ≈ 80%, diverticulitis and appendicitis ≈ 60% Change of antimicrobial therapy post-POCUS: 24% Overall identification of sepsis source: 89%
Devia Jaramillo et al., 2021, Colombia, POS cohort, single-center ED [19]	USER	US-based protocol for fluid administration and initiation of vasopressors in septic shock.	83/>18 yo in septic shock	Statistically significant difference in fluid balance: ○ at 4 h: standard care median 1325 mL vs. USER use 900 mL ○ at 6 h: standard care median 1658 mL vs. USER use 1107 mL ○ total fluid balance of hospital stay: standard care median 14,564 mL vs. USER use 8660 mL With USER, MAP ≥ 65 mmHg was achieved in 97.4% within 4 h
Haydar et al., 2012, USA, POS, single-center ED [20]	Protocol consisting of 3 main POCUS measures	Effect of 3 POCUS measures on clinical decision-making	74/>18 yo	Sepsis 37%, severe sepsis 40%, Septic Shock 22%, SIRS 1% Post-POCUS change of Certainty, measured in 100 mm VAS for sepsis, severe sepsis, septic shock, SIRS respectively: ○ about the cause: +5.6, 12.7, 9.5, 4 mm ○ about planned interventions: +0.3, 9.9, 2.2, 4 mm ○ about interventions foreseen: +12.3, 1.5,6.4, 7 mm ○ about choosing correct series of interventions: +9.9, 5.1, 7.8, 8 ○ about disposition: +8.1, 7.8, 5.4, 7 mm Overall Certainty change: (+): 71%, (−): 29% Change of the cause: 17% Change of the procedural intervention plans: 27% Change of overall treatment plans: 53% Mean clinical utility score: 65 mm, with usefulness reported in all cases
Musikatavorn et al., 2020, RCT, single-center ED [21]	IVC assessment	Effect of UGFM strategy on 30-d mortality in patients with septic shock or sepsis-indued hypoperfusion vs. standard care.	202/>18 yo	no significant difference in 30-day overall mortality s (18.8% and 19.8% in the usual-care and UGFM strategy, respectively; p > 0.05) less volume of cumulative fluid administered in the UGFM compared to standard care study group (1.900 mL vs. 2.600 mL the first 6 h, respectively, p < 0.001)
Lafon et al., 2020, France, POS, single-center ED [22]	FOCUS	FOCUS-based evaluation of early hemodynamic profile in patients presenting with ACF	100/>18 yo presenting with ACF	Sepsis cohort: 55 patients, Non-Sepsis: 45 patients. FOCUS was performed after administration of 500 mL of crystalloids Patients with sepsis had qSOFA score ≥ 2 points on ED admission and: More frequent CNS dysfunction Significantly increased heart rate and hemoglobin level LV hyperkinesia associated with profound vasoplegia and hypovolemia Reduced IVC size

* All studies included non-traumatic septic patients. Abbreviations: ACF = Acute circulatory failure; CNS = Central nervous system; ED = Emergency department; FOCUS = Focused echocardiography; IVC = Inferior vena cava; LV = Left ventricle; MAP = Mean arterial pressure; POCUS = Point-of-care ultrasound; POS = Prospective observational study; qSOFA = quick Sequential organ failure assessment; SIRS = Systemic inflammatory response syndrome; US = Ultrasound; USER = Ultrasound for emergency room; VAS = Visual analog scale; vs. = Versus; yo = Years old.