Sepsis bundle
Formal Definition
A set of time-sensitive interventions for the early management of sepsis and septic shock, derived from the Surviving Sepsis Campaign guidelines; includes within 3 hours: measure lactate, obtain blood cultures, administer broad-spectrum antibiotics, and give 30 mL/kg crystalloid for hypotension or lactate >=4 mmol/L; within 6 hours: re-measure lactate, apply vasopressors for refractory hypotension, and re-assess volume status.
How It's Used on the Ward
Sepsis bundle or the 3-hour bundle — the checklist of things you have to do within 3 hours when a patient has sepsis.
Example
"Sepsis alert: lactate 4.8, BP 85/50, RR 28, SpO2 91%, WBC 2.1. 3-hour sepsis bundle initiated: blood cultures drawn (2 sets), levofloxacin 750mg IV + piperacillin-tazobactam 4.5g IV started within 32 minutes. Lactated Ringer's 30 mL/kg (2.1L for 70kg patient) running wide open. Reassess lactate in 6 hours. Vasopressors ready at bedside if MAP <65 despite fluids."
Clinical Context
Hour-1 bundle (updated 2018): measure lactate, blood cultures, broad-spectrum antibiotics, crystalloid 30 mL/kg for hypotension or lactate >=4, vasopressors within 1 hour to maintain MAP >=65. QSOFA (quick SOFA): RR >=22, altered mentation, SBP <=100 — triggers suspicion but does not replace SIRS criteria for bundle initiation. Hour-3 bundle is now the standard; Hour-1 bundle merged the old 3h and 6h bundles into immediate action. Broad-spectrum antibiotics: cover gram-negatives, gram-positives, and anaerobes (e.g., piperacillin-tazobactam, cefepime, meropenem); narrow within 48-72h based on cultures.