Sepsis remains a significant cause of morbidity and mortality. Several national and international organisations have been pressing for earlier diagnosis and treatment of this life-threatening syndrome.

Sepsis care bundles:

The Surviving Sepsis campaign launched a set of clinical care bundles to standardise and improve care of patients with sepsis in 2004. They are reproduced below. More information and evidence base supporting these bundles can be found here.

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.

The Sepsis Six:

More recently, the Survive Sepsis campaign produced the Sepsis Six, a simplified version of the clinical bundles which any junior healthcare worker should be able to initiate and perform as part of a multidisciplinary team.

1. Administer high flow oxygen
2. Take blood cultures
3. Give broad spectrum antibiotics
4. Give intravenous fluid challenges
5. Measure serum lactate and haemoglobin
6. Measure accurate hourly urine output