Surviving Sepsis Campaign 2018 bundle update: begin resuscitation within 1 hour, not 3

  • Levy MM & al.
  • Intensive Care Med
  • 19 Apr 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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  • Sepsis treatment should begin within 1 hour of presentation.

Why this matters

  • Completion of Surviving Sepsis Campaign (SSC) 3-hour bundle, not including fluid bolus, is linked to survival.


  • Editorial with updated bundle based on 2016 SSC edition.
  • Authors are SSC members involved with authoring SSC bundles.
  • Bundle combines actions in previous 3- and 6-hour bundles “with the explicit intention of beginning resuscitation and management immediately.”

Key details

  • Measure lactate; if >2 mmol/L, repeat after 2-4 hours (weak recommendation, low evidence quality).
  • Obtain aerobic, anaerobic blood cultures before antibiotic administration; do not delay latter to obtain former (best practice).
  • Begin empiric broad-spectrum antibiotics (strong recommendation, moderate evidence quality).
  • If hypotension or lactate >4 mmol/L, give, e.g., 30 mL/kg intravenous crystalloid fluid (strong recommendation, low evidence quality).
    • Exercise caution continuing fluids in fluid-unresponsive patient; evidence suggests harm with ongoing positive fluid balance.
  • With hypotension during/after fluid resuscitation, begin vasopressors for mean arterial pressure ≥65 mmHg (strong recommendation, moderate evidence quality).


  • Suboptimal evidence quality for most elements.
  • Insufficient data for subgroups (immunocompromised, burn patients).

Additional information

  • Several days after this article appeared online, Intensive Care Medicine released expert consensus statement on managing hypovolemia in patients with sepsis.
  • This article simultaneously appeared in Critical Care Medicine.

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