UMEM Educational Pearls

• The current Surviving Sepsis Campaign Guidelines recommend treating septic patients with bundled care to improve outcomes. 
• The first bundle should be completed within 3 hours of suspicion of sepsis and includes:
  • Obtain blood cultures before antibiotics
  • Obtain lactate level
  • Administer broad-spectrum antibiotics
  • Administer 30mL/kg crystalloid fluid for hypotension  (MAP <65, lactate >4)

• A recent study in Critical Care Medicine examined the time frame when the delay of specific 3-hour bundle guideline recommendations applied to severe sepsis or septic shock becomes harmful and impacts mortality.
• Retrospective cohort study of all adult patients hospitalized with severe sepsis or septic shock from January 2011 to July 31, 2015. Of the 5,072 patients enrolled, 95.8% received the 3-hour bundle.
• Results:
  • Overall in-hospital mortality = 27.8%
  • If patient did not receive any of the 3-hr bundle items, in-house mortality = 41.1%
  • Statistically significant delays were linked to increased mortality for all bundle items
  • Delays beyond 3 hours were associated with minimal additional harm already caused by the 3-hour delay

Bottom Line: Implement sepsis protocols as soon as sepsis is suspected prior to the end of the 3 hour treatment window.

 

 

References

1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock,2012.Intensive Care Med 2013;39:165-228.
2. Surviving Sepsis Campaign Executive Committee: Updated Bundles in Response to New Evidence. 2015.Available at: http://www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf. Accessed Mar 31, 2018.
3. Pruinelli L, Westra BL, Yadav P, et al. Delay within the 3-hour surviving sepsis campaign guidelines on mortality for patients with severe sepsis and septic shock. Crit Care Med. 2018;46:500-505.