Written by Shannon Markus
Spoon Feed
Among patients with suspected sepsis in the ED, the implementation of a 1-hour sepsis bundle was not associated with significant difference in in-hospital mortality.
Going nowhere fast?
Early identification and management of sepsis and septic shock are crucial. The international Surviving Sepsis Campaign (SSC) recommends a sepsis bundle incorporating early lactate measurement, microbiological culture, antibiotherapy, and 30 mL/kg fluid resuscitation for those with hypotension or lactate >4. A 2018 update recommended initiating this bundle within 1 hour of triage; however, there are challenges in practical application. The 1BED trial, conducted in 23 emergency departments across France and Spain, evaluated the effectiveness of the 1-hour bundle against usual care. The trial involved a stepped-wedge cluster randomized design and included 872 patients with suspected sepsis. Results showed no significant reduction in 28-day in-hospital mortality (intervention group 12.1% vs. 12.6% in controls). Secondary outcomes, including fluid administration, presence of acute heart failure (iatrogenic fluid overload), SOFA score, ICU days, mechanical ventilation days, CRRT days, vasopressor-free days, unnecessary antibiotic use, and overall 28-day mortality, also showed no significant differences.
Low patient enrollment and difficulty implementing the 1-hour bundle hindered the study – only 63.5% received antibiotics within one hour. The study’s constraints suggest the need for further research to determine the bundle’s efficacy and to address practical implementation challenges.
How will this affect my practice?
It seems like the 1-hour sepsis bundle is difficult to accomplish and perhaps not strictly necessary for mortality reduction, but the principles of early identification and timely management of sepsis are still crucial. In my practice, I will focus on early and careful clinical evaluation, rapid response as indicated, and support of sepsis quality improvement initiatives.
Source
Effect of the 1-h bundle on mortality in patients with suspected sepsis in the emergency department: a stepped wedge cluster randomized clinical trial. Intensive Care Med. 2024 Jul;50(7):1086-1095. doi: 10.1007/s00134-024-07509-1. Epub 2024 Jun 24. PMID: 38913098.
