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Sepsis — 1-Hour Bundle

Surviving Sepsis Campaign 1-hour bundle for suspected sepsis and septic shock

Overview

  • Surviving Sepsis Campaign 1-hour bundle for suspected sepsis and septic shock

Protocol steps

  • id: 1; title: Measure Lactate; detail: Draw lactate level. If lactate >2 mmol/L, re-measure within 2-4 hours to guide resuscitation.; time: ; drugs:
  • id: 2; title: Obtain Blood Cultures; detail: Draw 2 sets of blood cultures (aerobic + anaerobic) BEFORE administering antibiotics. Do not delay antibiotics >45 min for cultures.; time: ; drugs:
  • id: 3; title: Administer Broad-Spectrum Antibiotics; detail: Start empiric IV antibiotics within 1 hour of recognition. Cover likely source.; time: ; drugs: name: Piperacillin-Tazobactam; dose: 4.5g IV; name: Vancomycin; dose: 25-30 mg/kg IV (if MRSA risk)
  • id: 4; title: IV Fluid Resuscitation; detail: Begin 30 mL/kg crystalloid (LR or NS) for hypotension or lactate ≥4 mmol/L. Start within first hour.; time: ; drugs:
  • id: 5; title: Reassess Volume Status; detail: If hypotension persists after initial fluid bolus, assess fluid responsiveness (passive leg raise, pulse pressure variation, bedside echo).; time: ; drugs:
  • id: 6; title: Start Vasopressors; detail: If MAP <65 despite fluids, start vasopressors. Target MAP ≥65 mmHg. Central line preferred but peripheral OK short-term.; time: ; drugs: name: Norepinephrine; dose: 0.1-0.5 mcg/kg/min IV; interval: titrate to MAP ≥65; name: Vasopressin; dose: 0.03 units/min IV; interval: add if NE >0.25 mcg/kg/min
  • id: 7; title: Re-measure Lactate; detail: Repeat lactate at 2-4 hours. Target lactate clearance >10% from initial value. Persistent elevation indicates ongoing hypoperfusion.; time: ; drugs:
  • id: 8; title: Source Control; detail: Identify and control source of infection: drain abscesses, remove infected devices, surgical debridement if indicated. Aim for source control within 6-12 hours.; time: ; drugs:

Source and review

  • Surviving Sepsis Campaign Guidelines 2021; Evans et al., Intensive Care Med 2021. Last reviewed: 2024-11-01