UMEM Educational Pearls

  • The current Surviving Sepsis Campaign Guidelines recommend treating septic patients with bundled care to improve outcomes. 
  • The first bundle should be completed within 3 hours of suspicion of sepsis and includes:
    • Obtain blood cultures before antibiotics
    • Obtain lactate level
    • Administer broad-spectrum antibiotics
    • Administer 30mL/kg crystalloid fluid for hypotension  (MAP <65, lactate >4)
  • A recent study in Critical Care Medicine examined the time frame when the delay of specific 3-hour bundle guideline recommendations applied to severe sepsis or septic shock becomes harmful and impacts mortality.
  • Retrospective cohort study of all adult patients hospitalized with severe sepsis or septic shock from January 2011 to July 31, 2015. Of the 5,072 patients enrolled, 95.8% received the 3-hour bundle.
  • Results:
    • Overall in-hospital mortality = 27.8%
    • If patient did not receive any of the 3-hr bundle items, in-house mortality = 41.1%
    • Statistically significant delays were linked to increased mortality for all bundle items
    • Delays beyond 3 hours were associated with minimal additional harm already caused by the 3-hour delay

Bottom Line: Implement sepsis protocols as soon as sepsis is suspected prior to the end of the 3 hour treatment window.




  1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock,2012.Intensive Care Med 2013;39:165-228.
  2. Surviving Sepsis Campaign Executive Committee: Updated Bundles in Response to New Evidence. 2015.Available at: Accessed Mar 31, 2018.
  3. Pruinelli L, Westra BL, Yadav P, et al. Delay within the 3-hour surviving sepsis campaign guidelines on mortality for patients with severe sepsis and septic shock. Crit Care Med. 2018;46:500-505.