Challenging the One-hour Sepsis Bundle

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Clinical Practice Guidelines

Background:

• The Surviving Sepsis Campaign (SSC) updated its sepsis bundle in April 2018.
• The new bundle integrated previous three-hour and six-hour directives.
• The rationale and evidence for these changes were presented by the guideline authors.

Purpose of the Study:

• To critically evaluate the evidence base for the updated SSC one-hour sepsis bundle.
• To highlight potential limitations in the methodological quality of supporting research.
• To review the existing, albeit limited, evidence underpinning the one-hour bundle.

Main Methods:

• Narrative review of existing literature.
• Analysis of the methodological quality of studies supporting the SSC guidelines.
• Examination of evidence supporting the one-hour sepsis bundle.

Main Results:

• The evidence supporting the current SSC one-hour bundle recommendations may be limited.
• Methodological weaknesses in the underlying research could impact the strength of recommendations.
• Existing data suggest potential discrepancies between recommendations and robust scientific evidence.

Conclusions:

• The foundation of the current one-hour sepsis bundle requires scrutiny due to limited and potentially weak evidence.
• Further high-quality research is needed to validate or refine sepsis management guidelines.
• Clinical practice should consider the limitations of the current evidence base when implementing sepsis bundles.