COMMENTARY

Surviving Sepsis Campaign: The Takeaways

Mitchell M. Levy, MD

Disclosures

September 10, 2014

Editorial Collaboration

Medscape &

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Hello. I am Dr. Mitchell Levy, co-chair of the Surviving Sepsis Campaign Management Guidelines Committee. I'm pleased to be speaking with you today as part of CDC Expert Commentary series on Medscape. Today I'm going to talk about translating research to the bedside for the management of sepsis.

In February 2013, the third edition of the Surviving Sepsis Campaign International Guidelines for Management of Severe Sepsis and Septic Shock was published. Also updated in this edition of the guidelines are the Surviving Sepsis Campaign Bundles to facilitate adoption of the clinical recommendations detailed in the guidelines. A bundle is a selected set of elements of care distilled from evidence-based practice guidelines that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone. Using bundles simplifies the complex processes of the care of patients with severe sepsis.

Bundles are an important part of the sepsis management guideline because diffusion of knowledge from bench to bedside tends to be very slow. In fact, studies have shown that the perception vs practice gap is significant. Evidence-based bundles can improve outcomes.

To test the bundles, the Surviving Sepsis Campaign partnered with the Institute for Healthcare Improvement (IHI). Together we conducted a global, multicenter, 7-year trial from 2005 to 2012 with multiple hospital networks to look at mortality outcomes when the bundles were implemented.

The results of the 7-year analysis of 30,000 patients showed a statistically significant 27% reduction in mortality. We also observed an association with high compliance sites having even larger reductions in mortality, ranging from a 36% reduction in high compliance sites with at least 3 years of data to a 39% reduction in mortality in high compliance sites with at least 48 months of data.

The Surviving Sepsis Campaign Bundles currently include a set of clinical practices to be completed within 3 hours and within 6 hours of encountering a patient with suspected sepsis. In the first 3 hours, clinicians should:

 • Measure lactate level;

 • Obtain blood cultures;

 • Administer broad-spectrum antibiotics; and

 • Administer crystalloid solution for hypotension (30 mL/kg) or for a lactate level ≥ 4 mmol/L.

Within the first 6 hours of having a patient with suspected sepsis, clinicians should:

 • Administer vasopressors for hypotension that does not respond to initial fluid resuscitation, to maintain a mean arterial pressure ≥ 65 mm Hg;

 • If arterial hypotension persists despite volume resuscitation or if the initial lactate is ≥ 4 mmol/L, measure central venous pressure and central venous oxygen saturation; and

 • Remeasure lactate level if initial lactate was elevated.

Each hospital's sepsis protocol may be customized, but it should meet the standards listed in the bundles. The Surviving Sepsis Campaign has created implementation kits with posters, pocket guides, bundle cards, lapel pins, and a list of resources to aid your implementation efforts using the most recent edition of the international sepsis guidelines.

Please see the Web Resources links on this page, and help us protect more patients by implementing the Surviving Sepsis Campaign Bundles and recommendations in your facility.

Thank you.

Web Resources

Surviving Sepsis Campaign

Surviving Sepsis Campaign International Guidelines for Management of Severe Sepsis and Septic Shock

Surviving Sepsis Campaign Bundles

   • 3-hour bundle

   • 6-hour bundle

Sepsis

Mitchell M. Levy, MD, FCCM, FCCP, is Medical Director of the Medical Intensive Care Unit at Rhode Island Hospital and Professor of Medicine and Division Chief of Pulmonary and Critical Care Medicine at The Warren Alpert Medical School of Brown University in Providence, Rhode Island.

Dr. Levy is a council member of the Society of Critical Care Medicine and is co-chair of the Surviving Sepsis Campaign Management Guidelines Committee. He also serves as a senior editor for the Journal of Critical Care as well as chair of the Robert Wood Johnson Critical Care End-of-Life Work Group, a group he has led since its inception in 1998.

Dr. Levy has held leadership positions in the American College of Chest Physicians and the American Thoracic Society. In 2001, Dr. Levy chaired the International Educational and Scientific Symposium of the Society of Critical Care Medicine, an organization that also awarded Levy its Award of Ethics and Distinguished Service Award.

Upon receiving his medical degree from the University of Buffalo, Dr. Levy completed his residency training at the University of Colorado Health System. He is a fellow of the American College of Critical Care Medicine and the American College of Chest Physicians.

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