The Sepsis Six Resuscitation Bundle

1. High flow oxygen

  • Optimise oxygenation as per the Oxygen Policy

2. Blood cultures
Within 1 hour

  • Take 2 pairs (from different sites)
  • Preferably should be taken before - but should not delay - antibiotic administration
  • Does the patient have a productive cough? Leaking wound? Cloudy or smelly urine? If so, obtain samples.

3. Early Intravenous Antibiotics
Within 1 hour

  • Ensure good communication with the doctor; ensure you are aware when antibiotics have been prescribed and administer ASAP.

DO NOT DELAY: In Severe Sepsis, every hour delay in antibiotic administration increases mortality by 4.

4. Early Fluid Resuscitation

If systolic BP < 90mmHg or Lactate > 2.0 give:

  • 20ml/kg crystalloid (e.g. Hartmann's solution) over 15 mins
  • This can be commenced by nurses PRIOR to medical review based on the PGD for Hartmann's solution

5. Serum lactate

  • Can be taken as venous or arterial blood gas sample
  • High lactate indicates tissue hypoperfusion and even identifies patients at risk who are not hypotensive

6. Catheterise - assess urine output

  • If BP remains low or if there is evidence of acute kidney injury then consider catheterising early
  • Strict input/output fluid balance
  • Aim Urine Output > 30ml/hr

Acute Kidney Injury is a FREQUENT complication of Severe Sepsis.

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