Bundles

​The Surviving Sepsis Campaign Bundles are the core of the sepsis improvement efforts. Using "bundles" simplifies the complex processes of the care of patients with severe sepsis. A bundle is a selected set of elements of care distilled from evidence-based practice guidelines that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone. Each hospital's sepsis protocol may be customized, but it must meet the standards created by the bundle. Enhancing reliability of these bundle elements allows teams to focus on aspects of the changes they are implementing to create a reliable system that achieves the goal of 25 percent reduction in mortality due to sepsis called for by the Surviving Sepsis Campaign.

Surviving Sepsis Campaign Bundles

TO BE COMPLETED WITHIN 3 HOURS:
1) Measure lactate level
2) Obtain blood cultures prior to administration of antibiotics
3) Administer broad spectrum antibiotics
4) Administer 30 ml/kg crystalloid for hypotension or lactate ≥4mmol/L

TO BE COMPLETED WITHIN 6 HOURS:
5) Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65 mm Hg
6) 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)*
7) Remeasure lactate if initial lactate was elevated*

*Targets for quantitative resuscitation included in the guidelines are CVP of ≥8 mm Hg; ScvO2 of ≥70%, and normalization of lactate.


3-Hour Bundle
1) Measure Lactate Level
2) Obtain Blood Cultures Prior to Administration of Antibiotics
3) Administer Broad Spectrum Antibiotics
4) Administer 30 mL/kg Crystalloid for Hypotension or Lactate ≥4 mmol/L
 
1) Apply Vasopressors (for Hypotension That Does Not Respond to Initial Fluid Resuscitation) to Maintain a Mean Arterial Pressure (MAP) ≥65 mm Hg
2) In the Event of Persistent Arterial Hypotension Despite Volume Resuscitation (Septic Shock) or Initial Lactate ≥4 mmol/L (36 mg/dL):
      a. Maintain Adequate Central Venous Pressure
      b. Maintain Adequate Central Venous Oxygen Saturation
3) Remeasure Lactate If Initial Lactate Was Elevated