Severe Sepsis Bundles

​The Severe Sepsis Bundles have been revised in conjunction with the updated 2012 International Guidelines for Management of Severe Sepsis and Septic Shock. As a result:

  • The previous version of the Sepsis Resuscitation Bundle has been modified into two bundles: the Severe Sepsis 3-Hour Resuscitation Bundle and the 6-Hour Septic Shock Bundle
  • The Sepsis Management Bundle — part of the previous version of the Severe Sepsis Bundles — has been eliminated, and Other Supportive Therapies have been added


The Severe Sepsis 3-Hour Resuscitation Bundle contains the following elements, to be completed within 3 hours of the time of presentation with severe sepsis:

  • Measure Lactate Level
  • Obtain Blood Cultures Prior to Administration of Antibiotics
  • Administer Broad Spectrum Antibiotics
  • Administer 30 mL/kg Crystalloid for Hypotension or Lactate ≥4 mmol/L


The 6-Hour Septic Shock Bundle contains the following elements, to be completed within 6 hours of the time of presentation with severe sepsis:

  • Apply Vasopressors (for Hypotension That Does Not Respond to Initial Fluid Resuscitation to Maintain a Mean Arterial Pressure (MAP) ≥65 mm Hg)
  • In the Event of Persistent Arterial Hypotension Despite Volume Resuscitation (Septic Shock) or Initial Lactate ≥4 mmol/L (36 mg/dL):
    • Measure Central Venous Pressure (CVP)
    • Measure Central Venous Oxygen Saturation (ScvO2)
  • Remeasure Lactate If Initial Lactate Was Elevated


Some bundle elements may not be completed if the clinical conditions described in the bundle do not prevail, but clinicians must assess for those conditions and make a determination. The intention in applying the bundle is to perform all indicated tasks 100 percent of the time within the first 6 hours of identification of severe sepsis.

 

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