SePsis bundle 2018



  1. The most important change in the revision of the SSC bundles is that the 3-h and 6-h bundles have been combined into a single “hour-1 bundle” with the explicit intention of beginning resuscitation and management immediately. We believe this reflects the clinical reality at the bedside of these seriously ill patients with sepsis and septic shock—that clinicians begin treatment immediately, especially in patients with hypotension, rather than waiting or extending resuscitation measures over a longer period. More than 1 hour may be required for resuscitation to be completed, but initiation of resuscitation and treatment, such as obtaining blood for measuring lactate and blood cultures, administration of fluids and antibiotics, and in the case of life-threatening hypotension, initiation of vasopressor therapy, are all begun immediately. It is also important to note that there are no published studies that have evaluated the efficacy in important subgroups, including burns and immunocompromised patients. This knowledge gap needs to be addressed in future studies specifically targeting these subgroups. The elements included in the revised bundle are takenrom the Surviving Sepsis Campaign Guidelines, and the level of evidence in support of each element can be seen in Table 1 (12, 13). We believe the new bundle is an accurate reflection of actual clinical care


MeasureMeasure lactate level. Re-measure if initial lactate is > 2 mmol/L


Obtain blood cultures prior to administration of antibiotics Administer broad-spectrum antibiotics


Rapidly administer 30 mL/kg crystalloid for hypotension or lactate ≥ 4 mmol/L


Apply vasopressors if patient is hypotensive during or after f luid resuscitation to maintain mean arterial pressure ≥ 65 mm Hg lactate level.


About Dr. Jayaprakash

Asst. Prof. of Pediatrics, ICH. Institute of Child Health. Gov. Medical College Kottayam. Kerala, India.

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