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Sunday, September 20, 2009

Surviving Sepsis Campaign

Surviving Sepsis Campaign: "Sepsis Resuscitation Bundle
The Sepsis Resuscitation Bundle describes seven tasks that should begin immediately, but must be accomplished within the first 6 hours of presentation for patients with severe sepsis or septic shock. Some items may not be completed if the clinical conditions described in the bundle do not prevail in a particular case, but clinicians should assess for them. The goal is to perform all indicated tasks 100 percent of the time within the first 6 hours of identification of severe sepsis."

Severe Sepsis Bundles:
Sepsis Resuscitation Bundle

(To be accomplished as soon as possible and scored over first 6 hours):
1. Serum lactate measured.
2. Blood cultures obtained prior to antibiotic administration.
3. From the time of presentation, broad-spectrum antibiotics administered within 3 hours for
ED admissions and 1 hour for non-ED ICU admissions.
4. In the event of hypotension and/or lactate > 4 mmol/L (36 mg/dl):
a) Deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent*).
b) Apply vasopressors for hypotension not responding to initial fluid resuscitation to
maintain mean arterial pressure (MAP) > 65 mm Hg.
5. In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or
lactate > 4 mmol/L (36 mg/dl):
a) Achieve central venous pressure (CVP) of > 8 mm Hg.
b) Achieve central venous oxygen saturation (ScvO2) of > 70%.**

Sepsis Management Bundle

(To be accomplished as soon as possible and scored over first 24 hours):
1. Low-dose steroids* administered for septic shock in accordance with a standardized ICU
policy.
2. Drotrecogin alfa (activated) administered in accordance with a standardized ICU policy.
3. Glucose control maintained > lower limit of normal, but < 150 mg/dl (8.3 mmol/L).
4. Inspiratory plateau pressures maintained < 30 cm H2O for mechanically ventilated
patients.