Hour-1 Bundle: The process & the details

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 SSC Governance
Executive Committee

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of Intensive Care Medicine. All Rights Reserved
 Steering Committee

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of Intensive Care Medicine. All Rights Reserved
 What Bodies Are Responsible For
Guidelines & Bundle Updates?
SSC
Steering
Committee

SSC
Executive
Committee
External
SSC Guidelines Stakeholder
Co-chairs & Organizations
Co-vice chairs and Advisory
Groups

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of Intensive Care Medicine. All Rights Reserved
 What Are Bundle Updates Based Upon?

Potential Bundle Revision Triggers Include (but are not

limited to):

 Surviving Sepsis Campaign (SSC) guidelines revision published (option

to include bundle updates in the guidelines )
 Breaking new clinical trials published
 Dataset analysis indicating a need for revision
 Evidence supporting a bundle revision provided by details in the most
recent (or concurrent) guideline

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of Intensive Care Medicine. All Rights Reserved
 Additional Potential Considerations
for Revision:

Potential for lives saved;

Quantity and quality of the evidence suggesting the revisions;

Identification and involvement of stakeholders likely to be affected by the revisions;

Impact of the revisions on retrieval of related outcomes data within the electronic health record;

Implications of the revised bundle implementation on education and process change for medical providers and health
systems;

Consideration of the time frame over which the revisions are realistically possible; and/or

Anticipation of unintended consequences of the revisions.

List may be modified over time.

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of Intensive Care Medicine. All Rights Reserved
 Hour-1 Bundle Elements
1) Measure lactate level.*
2) Obtain blood cultures before administering antibiotics.
3) Administer broad-spectrum antibiotics.
4) Begin rapid administration of 30 mL/kg crystalloid for hypotension
or lactate > 4 mmol/L.
5) Apply vasopressors if hypotensive during or after fluid resuscitation
to maintain a mean arterial pressure of > 65 mm Hg.

*Remeasure lactate if initial lactate elevated (> 2 mmol/L).

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of Intensive Care Medicine. All Rights Reserved
 Details on Bundle Implementation
The Surviving Sepsis Campaign hour-1 bundle should be viewed as a quality improvement
opportunity moving toward an ideal state.

For critically ill patients with sepsis or septic shock, time is of the essence.

Although the starting time for the hour-1 bundle is recognition of sepsis, both sepsis and septic shock
should be viewed as medical emergencies requiring rapid diagnosis and immediate intervention.

The hour-1 bundle encourages clinicians to act as quickly as possible to obtain blood cultures,
administer broad-spectrum antibiotics, start appropriate fluid resuscitation, measure lactate, and
begin vasopressors if clinically indicated.

Ideally these interventions would all begin in the first hour from sepsis recognition but may not
necessarily be completed in the first hour.

Minimizing the time to treatment acknowledges the urgency that exists for patients with sepsis and
septic shock.

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of Intensive Care Medicine. All Rights Reserved
 For Additional Information and Resources

Visit The Campaign Website:

http://www.survivingsepsis.org

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of Intensive Care Medicine. All Rights Reserved