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Timeline of sepsis bundle component completion and its association with septic shock outcomes

Bo Hu1, Hui Xiang2, Yue Dong3

  • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.

Journal of Critical Care
|August 18, 2020
PubMed

Insights

Completing sepsis bundles within 3 hours significantly lowers septic shock mortality. However, achieving completion in under 1 hour showed no additional survival benefit compared to the 3-hour timeframe.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Clinical Outcomes Research

Background:

  • Sepsis and septic shock are time-sensitive medical emergencies requiring rapid intervention.
  • The Surviving Sepsis Campaign (SSC) provides guidelines for timely sepsis management.
  • The impact of specific timelines for sepsis bundle completion on clinical outcomes remains an area of active investigation.

Purpose of the Study:

  • To evaluate the association between the timing of sepsis bundle completion and clinical outcomes in patients with septic shock.
  • To determine if faster completion of sepsis bundles (e.g., within 1 hour) offers superior benefits compared to completion within 3 hours.

Main Methods:

  • Retrospective study of adult patients diagnosed with septic shock at Mayo Clinic between January 2006 and May 2018.
  • Patients were categorized into three groups based on the time to complete sepsis bundle elements: <1 hour, 1.1 to 3 hours, and >3 hours post-diagnosis.
  • Clinical outcomes, including 28-day and 90-day mortality, were analyzed across the different completion time groups.

Main Results:

  • A total of 1052 septic shock patients were analyzed.
  • Patients completing sepsis bundles within 3 hours demonstrated significantly lower 28-day mortality (17.5%) compared to those taking longer (31.4%, p < .001).
  • Completion within 3 hours was also associated with improved 90-day survival (HR=0.67; 95% CI 0.55-0.80; p < .001). No significant difference in mortality or survival was observed between completion within 1 hour versus within 3 hours.

Conclusions:

  • Completion of sepsis bundle components within 3 hours is associated with reduced mortality and improved outcomes in septic shock.
  • The specific benefit of completing sepsis bundles in under 1 hour, compared to within 3 hours, was not statistically significant in this cohort.
  • Adherence to the 3-hour sepsis bundle timeframe is crucial for improving patient survival in septic shock.
Abstract

Keywords:
Care bundleResuscitatioSeptic shockSurviving sepsis campaign

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