UMEM Educational Pearls

Title: Timing Matters- Start Sepsis Treatment Early

Posted: 3/31/2018 by Ashley Martinelli (Updated: 11/13/2024)
Click here to contact Ashley Martinelli

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.

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.
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.
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.