Sepsis 1-Hour Bundle Components

Core Components of the Sepsis 1-Hour Bundle

The sepsis 1-hour bundle consists of five key interventions that must be completed within one hour of sepsis recognition: measuring lactate, obtaining blood cultures, administering broad-spectrum antibiotics, beginning fluid resuscitation, and starting vasopressors if indicated, as recommended by the Society of Critical Care Medicine 1, 2
Obtain serum lactate measurement, and if initial lactate is elevated, remeasure within 2-4 hours to guide resuscitation, according to the Intensive Care Medicine guidelines 1, 2, 3
Target normalization of lactate as a marker of tissue hypoperfusion, as suggested by the Intensive Care Medicine guidelines 2

Collect appropriate blood cultures before starting antimicrobial therapy, and obtain at least two sets of blood cultures, as recommended by the Intensive Care Medicine guidelines 1, 2, 4
Initiate intravenous antimicrobials within the first hour of sepsis recognition, and select antibiotics with activity against all likely pathogens, according to the Intensive Care Medicine and Critical Care Medicine guidelines 1, 2, 4, 5

Rapidly administer 30 mL/kg crystalloid fluid for patients with hypotension or lactate ≥4 mmol/L, and target a minimum initial bolus of 20 mL/kg, as recommended by the Intensive Care Medicine guidelines 1, 3
Use crystalloids as first-line fluid, and reassess frequently for signs of fluid overload, according to the Intensive Care Medicine guidelines 3, 6
Initiate vasopressors if patient remains hypotensive despite adequate fluid resuscitation, and target a mean arterial pressure (MAP) of 65 mmHg, as suggested by the Intensive Care Medicine and Critical Care Medicine guidelines 1, 2

Perform frequent reassessment of hemodynamic status, and monitor vital signs, capillary refill time, skin mottling, mental status, and urine output, as recommended by the Intensive Care Medicine guidelines 2, 3
Consider further hemodynamic assessment if clinical examination does not lead to a clear diagnosis, and use dynamic variables rather than static variables to predict fluid responsiveness when available, according to the Intensive Care Medicine guidelines 2