The New Sepsis 1-Hour Bundle

6/15/18 8:00 AM

Sepsis, a dysregulated response to infection, is a severe, life-threatening indication, affecting approximately 1.5 million people in the US every year and costing US hospitals $24 billion annually. Given this grim reality, various organizations such as The Surviving Sepsis Campaign (SSC) have formed in order to improve sepsis-related outcomes. The SSC was created by the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) in 2002. Since 2002, the SSC has created sepsis performance improvement programs, analyzed data, and written four editions of sepsis-related guidelines for practitioners to follow.

The most recent edition of guidelines is the “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.” In these guidelines, sepsis management is broken into five sections — hemodynamics, infection, adjunctive therapies, metabolics, ventilation — with each section including a list of evidence-based recommendations. In addition to the guidelines, the SSC creates sets of “sepsis bundles,” that clearly outline steps practitioners should take within the first three and six hours of sepsis diagnosis (“time zero” or “time of presentation”).

The SSC released a new bundle in 2018, the “hour-1 bundle,” based on findings that earlier sepsis detection and treatment leads to better patient outcomes. The bundle is based on components of the three and six hour bundles and includes specific actions that must be taken within a critical window of one hour.

Source — The Surviving Sepsis Campaign Bundle — 2018 Bundle

  1. Lactate levels are included in the bundle, as it is believed that high lactate levels are indicative of tissue perfusion and hypoxia. It has also been found that monitoring lactate levels can help determine proper resuscitation protocol.
  2. Blood culture should be taken before administration of antibiotics, because initial administration of antibiotics can lead to sterilization of cultures and make the identification of pathogens difficult.
  3. Upon taking samples for bloods culture analysis, broad-spectrum antibiotics must be immediately administered to patients. Antibiotic treatment can be narrowed once blood culture results have arrived and a specific pathogen is identified.
  4. Administer IV Fluid: It is recommended that IV fluids be given to patients if lactate levels are elevated or if the patient experiences hypotension. It is also suggested that this fluid therapy be completed within the first 3 hours of recognition, since fluid therapy beyond this timeframe can lead to positive fluid balance and adverse outcomes.
  5. Apply Vasopressors: Vasopressors allow perfusion pressure to increase and can mitigate hypoperfusion. It is recommended as an add-on treatment to fluid therapy if blood pressure isn’t restored after initial fluid therapy.

The SCC hopes that with the proper implementation of this revised bundle, sepsis outcomes will improve.

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