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Severe Sepsis/Septic Shock Early Management Bundle (SEP-1)

Earlier iteration, now simplified into 1 hour bundle. Indications: - more rapid completion of a 3-hour bundle of sepsis care associated with lower in hospital mortality [1] Epidemiology: - 54% adherence to the recommended bundle of clinical actions [2] Procedure: - 3 hour bundle, now 1 hour bundle see sepsis bundle, sepsis & septic shock [4] Complications: - risks of overtesting & overtreating patients with low probability of sepsis - diversion of attention away from more evidence-based time-sensitive tasks [5] Notes: - sepsis management protocols (bundles) not effective in all settings [3]

Related

sepsis septic shock

General

sepsis bundle (1 hour sepsis bundle)

References

  1. Seymour CW, Gesten F, Prescott HC et al Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. May 21, 2017 PMID: 28528569 http://www.nejm.org/doi/full/10.1056/NEJMoa1703058 - Hershey TB, Kahn JM. State Sepsis Mandates - A New Era for Regulation of Hospital Quality. N Engl J Med. May 21, 2017 PMID: 28528558 http://www.nejm.org/doi/full/10.1056/NEJMp1611928
  2. Venkatesh AK et al. Preliminary performance on the new CMS sepsis-1 national quality measure: Early insights from the Emergency Quality Network (E-QUAL). Ann Emerg Med. 2017 Aug 5. pii: S0196-0644(17)30872-7 PMID: 28789803 http://www.annemergmed.com/article/S0196-0644(17)30872-7/fulltext
  3. Andrews B, Semler MW, Muchemwa L et al. Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: A randomized clinical trial. JAMA 2017 Oct 3; 318:1233-1240. PMID: 28973227 - Machado FR, Angus DC. Trying to improve sepsis care in low-resource settings. JAMA 2017 Oct 3; 318:1225-1227. PMID: 28973226
  4. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 2018 Apr 19 PMID: 29675566 https://link.springer.com/article/10.1007%2Fs00134-018-5085-0
  5. Pallin DJ, Spiegel R The Surviving Sepsis Campaign: A Rush to Judgment. NEJM Journal Watch. Aug 3, 2018 Massachusetts Medical Society (subscription needed) http://www.jwatch.org