Standardized Multiorgan Ultrasound for the Emergency Evaluation of Sepsis and Septic Shock

Bedside ultrasound can identify cardiac, venous, pulmonary, and vascular abnormalities in sepsis, but variation in acquisition and reporting limits comparisons of procedural performance. This single-center prospective methodological study evaluated a standardized Rapid Ultrasound in Shock and Hypotension (RUSH) workflow in 101 consecutive adults with sepsis or septic shock. Each examination comprised 23 imaging nodes in a fixed Pump, Tank, and Pipes sequence, with predefined transducers, anatomical targets, recording durations, quality grades, and completion criteria. Image quality was graded from 0 to 2, with Grades 1 and 2 considered interpretable. Thirty stored examinations underwent independent secondary review. Four archived complete examinations were reviewed separately to illustrate integrated findings. Protocol adherence was achieved in 92/101 examinations (91.1%), and 74/101 (73.3%) met all module interpretability criteria. Pump, Tank, and Pipes completion rates were 96.0%, 85.1%, and 77.2%, respectively. Of 2,323 planned nodes, 2,227 (95.9%) were acquired and 2,161 (93.0%) were interpretable. Grade 2 images accounted for 79.9% of planned nodes. Median total elapsed time was 15.6 min, and median active scanning time was 13.7 min. The weighted kappa for image quality was 0.82 (95% confidence interval, 0.77-0.87), and intraclass correlation coefficients for diameter measurements ranged from 0.93 to 0.95. Most prescribed views could be acquired and interpreted under the study conditions, although fewer examinations satisfied every module criterion. Agreement on stored images supports consistency between readers. Independent acquisition reproducibility, diagnostic accuracy, and treatment benefit require separate evaluation.