EASy Sepsis Protocol
Acquire the focused exam → identify the hemodynamic phenotype → act on volume, vasopressor, inotrope or procedure → repeat as the phenotype migrates.
Start with EASy MAP. This protocol applies a framework it does not teach — the six views, ventricular and volume assessment, and the four clusters and ten phenotypes are covered in EASy MAP. With that behind you, EASy Sepsis is an application course: one syndrome, serially reassessed, from resuscitation through to de-resuscitation.
POCUS-guided hemodynamic assessment and resuscitation in septic shock
What is EASy Sepsis?
EASy Sepsis applies the EASy MAP framework specifically to septic patients, guiding fluid resuscitation, vasopressor selection, and identifying sepsis-induced cardiomyopathy.
The protocol complements guideline-based initial resuscitation: EASy helps individualize fluid, vasoactive, and de-resuscitation decisions beyond the initial bolus — dynamic reassessment rather than a fixed volume for everyone.
Key Principles
- Integrate, don't isolate — No single window decides anything — heart, IVC and lungs are read together, with the clinical context
- Not every septic patient needs more fluid — Tolerance is a separate question from responsiveness, and it is the one that limits the bolus
- Reassess after every intervention — The phenotype migrates; a reading is of this minute, not of this admission
When to Use EASy Sepsis
- Sepsis with hypotension (MAP < 65)
- Septic shock requiring vasopressors
- Unclear fluid responsiveness
- Failure to respond to initial resuscitation
- Concern for fluid overload
What the focused exam adds
The six EASy views, grouped into four assessments — heart, IVC, lungs and pleura — read together and never in isolation, alongside perfusion, ventilation, trajectory and context.
| Window | The question | What it adds |
|---|---|---|
| Heart | Which EASy cluster and phenotype is this? | Pump and chamber pattern |
| IVC | Flat, normal, or plethoric? | Venous filling and right-sided pressure context |
| Upper lungs | A-profile or B-profile? | Pulmonary aeration and interstitial syndrome |
| Pleura | Effusion, consolidation, or absent sliding? | A source, or an obstruction to relieve |
When the IVC is plethoric, consider further assessment for venous congestion
A plethoric IVC suggests elevated right-sided pressure but does not, by itself, establish clinically important organ congestion. In experienced hands, portal, hepatic and intrarenal venous Doppler may provide additional information.
EASy currently uses portal-vein Doppler — colour to confirm the vessel, pulsed wave to read the waveform — as a simplified screening signal. It is one bed read as a pattern, not a calculated index. This approach is educational and has not been validated as a substitute for the full VExUS examination, which grades congestion from the IVC together with hepatic, portal and intrarenal vein Doppler.
Findings suggesting congestion should prompt reassessment of fluid administration, perfusion, RV function, ventilation, renal function and the underlying cause. De-resuscitation may be considered once the patient is adequately perfused and clinically stable. Congestion findings do not set the intensity or the endpoint of that process, and combining a congestion grade with the EASy clusters has not been validated — a prospective multicentre sepsis study found a VExUS grade of 2 or more was not associated with acute kidney injury, renal replacement or mortality.
Acquisition, the pattern read and the false negatives are in the moduleHow it changes the next decision
The full framework is ten phenotypes across four clusters, taught in EASy MAP. What the cluster changes in sepsis:
| EASy pattern | Primary action |
|---|---|
| Cluster 1 — preserved or hyperdynamic pump | Measured fluid while it is still helping; vasopressor for the vasodilation that remains |
| Cluster 2 — LV or biventricular failure | Limit fluid. Pressure support, with targeted inotropy when perfusion stays poor |
| Cluster 3 — acute or acute-on-chronic RV failure | RV-protective management. Massive PE lives here, as P6 or P7 — not with the obstructive phenotypes |
| Cluster 4 — mechanical obstruction | Find the lesion and correct it. Tamponade, tension pneumothorax, dynamic hyperinflation |
The vasoactive default
The 2026 Surviving Sepsis Campaign recommends norepinephrine as the first-line vasopressor, suggests adding vasopressin as norepinephrine requirements escalate, and suggests adding epinephrine when the mean arterial pressure remains inadequate despite both. With cardiac dysfunction and persistent hypoperfusion, either dobutamine added to norepinephrine or epinephrine alone is suggested — the evidence does not separate them.
Surviving Sepsis Campaign International Guidelines, 2026 — read the recommendation strengths and the evidence certainty there, not here.
The phenotype does not replace that sequence. It helps identify which physiologic problem may deserve priority — volume, vascular tone, pump support, or a procedure. Treatment still depends on the full clinical assessment, perfusion endpoints, contraindications, and the response to serial reassessment. The receptor pharmacology and the trials behind the sequence are in the module.
Then look again
Repeat the exam after any meaningful fluid or vasoactive intervention, on deterioration, before giving more fluid, and when considering taking fluid off. A phenotype is a reading of this minute, and it migrates — physiology decides the next phase, not a fixed clock.
The hands-on workshop
EASy Sepsis is taught in a room with live models, machines and a case bank — because the exam is a psychomotor skill and the decision is a habit, and neither is acquired by reading.
1 · Acquisition, on live models
Every station has a machine and a model, and participants scan under direct faculty supervision. The subcostal window is found on a real body rather than a phantom — with the rib margin, the breath and the abdominal wall that make it difficult in the first place.
Faculty correct the hand as it happens: probe pressure, the angle onto the pericardium, and the rotation into the IVC. The aim of this hour is not interpretation. It is a picture good enough to interpret.
2 · Interpretation, out loud
A clip goes up and the group is asked before it is told. Do the walls thicken and does the chamber get smaller? Does the mitral annulus move vigorously? Does the anterior leaflet reach the septum?
Answering in front of colleagues is the point. A phenotype named silently is a guess; a phenotype named out loud can be challenged, and that is how the reading becomes reliable.
3 · Cases and management, in small groups
Seated, in small groups, working through a bank of around a hundred sepsis cases. Each one is a real set of clips with a real decision attached: name the cluster, choose between volume, vasopressor, inotrope and procedure, and say what you would look at again.
Management is argued rather than delivered. The cases that teach most are the ones where the group disagrees — mixed shock, chronic disease unmasked, and the patient whose phenotype has moved since the last look.
Enquire about hosting a workshopPractice with Sepsis Scenarios
Apply EASy Sepsis to challenging clinical scenarios
Every EASy application is one loop of the same pathway. See the next step in the pathway