Sepsis on speed
New York mandated hospital sepsis care protocols statewide. All patients had to have a blood culture before the administration of antibiotics, measurement of serum lactate level, and administration of broad-spectrum antibiotics within 3 hours. Within 6 hours, they were to give a bolus of 30 mL/kg of intravenous fluids in patients with hypotension or a serum lactate level of 4.0 mmol/L or, initiate vasopressors for refractory hypotension, and remeasure serum lactate within 6 hours after the initiation of the protocol. Reviewing data from >49,000 sepsis patients, they found that delayed antibiotic administration and delayed completion of the 3-hour sepsis bundle were associated with increased mortality, both with odds ratio 1.04 per hour; this means a 4% increased odds of death per hour delay. Timing of the fluid bolus was not associated with mortality reduction.
One of the most important tasks we do in sepsis care, after identifying it, is to start appropriate antibiotics as soon as possible. This is associated with mortality reduction. Journal Watch's Ali Raja has a quick spot-on summary of this article if you want to learn more.
Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. 2017 May 21. doi: 10.1056/NEJMoa1703058. [Epub ahead of print]
Peer reviewed by Thomas Davis.