Intensive Care Doctor-Community

Sepsis Resuscitation Bundle

Evidence-based goals that must be completed within 6 hours for patients with severe sepsis, septic shock and/or lactate > 4 mmol/L (36 mg/dL).

For patients with severe sepsis, as many as seven bundle elements must be accomplished within the first 6 hours of presentation. Some items may not be completed if the clinical conditions described in the bundle do not prevail, but clinicians must assess for them. The goal is to perform all indicated tasks 100 percent of the time within the first 6 hours of identification of severe sepsis.

Changes for Improvement

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Bundle Element 1: Measure serum lactate.

• Serum Lactate Measured

Bundle Element 2: Obtain blood cultures prior to antibiotic administration.

• Blood Cultures Obtained Prior to Antibiotic Administration

Bundle Element 3: Administer broad-spectrum antibiotic within 3 hours of ED admission and within 1 hour of non-ED admission.

• Improve Time to Broad-Spectrum Antibiotics

Bundle Element 4: In the event of hypotension and/or serum lactate >4 mmol/L:

a. Deliver an initial minimum of 20 mL/kg of crystalloid or an equivalent

b. Apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) >65 mm Hg

• Treat Hypotension and/or Elevated Lactate with Fluids
• Apply Vasopressors for Ongoing Hypotension

Bundle Element 5: In the event of persistent hyptension despite fluid resuscitation (septic shock) and/or lactate >4 mmol/L:

a. Achieve a central venous pressure (CVP) of >8 mm Hg

b. Achieve a central venous oxygen saturation (ScvO2) > 70% or mixed venous oxygen saturation (SvO2) > 65%

• Maintain Adequate Central Venous Pressure
• Maintain Adequate Central Venous Oxygen Saturation