Completing Sepsis Bundle Within an Hour Cuts Pediatric Mortality

However, completing individual bundle elements in that timeframe does not reduce pediatric mortality.
However, completing individual bundle elements in that timeframe does not reduce pediatric mortality.

HealthDay News — Completion of a 1-hour sepsis bundle within 1 hour cuts mortality in pediatric patients, according to a study published in the July 24/31 issue of the Journal of the American Medical Association.

Idris V.R. Evans, MD, from the University of Pittsburgh, and colleagues assessed whether completing the pediatric sepsis bundle elements (blood cultures, broad-spectrum antibiotics, and at least one 20mL/kg bolus of intravenous fluid) within 1 hour improves outcomes. The analysis included 1179 patients (mean age, 7.2 years) with sepsis and septic shock reported to the New York State Department of Health who had a sepsis protocol initiated. 

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The researchers found that the entire sepsis bundle was completed in 1 hour in just about one-quarter of patients (24.9%). Within the 1-hour timeframe, antibiotics were administered to 67.7% of patients, blood cultures to 62.8%, and the fluid bolus to 46.5%. Completing the entire bundle within 1 hour was associated with a lower risk of in-hospital mortality (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.38 to 0.93; P=.02). However, there was not a significant lower risk-adjusted mortality associated with completing each element in the bundle within an hour (blood culture: OR, 0.73 [95% CI, 0.51 to 1.06; P=.10]; antibiotics: OR, 0.78 [95% CI, 0.55 to 1.12; P=.18]; and fluid bolus: OR, 0.88 [95% CI, 0.56 to 1.37; P=.56]).

"It's clear that completing the entire sepsis protocol within an hour is associated with lower mortality," Evans said in a statement. "But the mechanism of benefit still requires more study. Does each element of the protocol contribute to specific biologic or physiologic changes that, when combined, improve outcomes? Or is it that completion within an hour may simply be an indication of greater awareness by doctors and nurses caring for the child? Or could it be something else entirely?"

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