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BMJ. 2007 November 17; 335(7628): 1007.
PMCID: PMC2078618
Managing Sepsis

Surviving sepsis campaign's recommendations

Lindsay E M Reid, foundation year 2

MacKenzie and Lever describe the management of sepsis in some detail.1 As one who is often responsible for the initial diagnosis and management, I find recommendations from the surviving sepsis campaign helpful. This campaign was formed in 2002 to combat worsening trends in the incidence and mortality relating to sepsis.2

This means that if a patient has two or more of the systemic inflammatory response criteria (box 1), then the six hour resuscitation bundle should be triggered (box 2). The first four steps can be carried out immediately on the ward. There has been clear evidence for the positive effect of these interventions on morbidity and mortality relating to sepsis.2 3 4

Box 1 Systemic inflammatory response criteria

  • Temperature <36°C or >38°C
  • Respiratory rate >20 breaths/minute
  • Heart rate >90 beats/minute
  • White blood cell count <4×109 cells/l or >12×109 cells/l

Box 2 Sepsis resuscitation bundle

  • 1. Measure serum lactate
  • 2. Obtain blood cultures before giving antibiotics
  • 3. Give broad spectrum antibiotics quickly
  • 4. Treat hypotension or raised lactate (or both) with fluids
  • 5. Give vasopressors for ongoing hypotension
  • 6. Maintain adequate central venous pressure
  • 7. Maintain adequate central venous oxygen saturation

A recent audit we conducted in a district general hospital showed these interventions were not being instigated regularly—in patients fulfilling criteria for sepsis, only 57% had blood cultures within six hours, 30% had serum lactate measured, 53% had arterial blood gases measured, 80% were given empirical antibiotics, and 97% had adequate fluid resuscitation. Reports suggest that this reflects the situation elsewhere.5

Better education regarding these simple interventions would be a good start to tackling failings in the diagnosis and initial management of sepsis.


Competing interests: None declared.


1. Mackenzie I, Lever A. Management of sepsis. BMJ 2007;335:929-32. (3 November.) [PMC free article] [PubMed]
2. Poulton B. Advances in the management of sepsis: the randomised controlled trials behind the surviving sepsis campaign recommendations. Int J Antimicrob Agents 2006;27:97-101. [PubMed]
3. Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalised with community-acquired pneumonia. Arch Intern Med 2004;164:637-44. [PubMed]
4. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77. [PubMed]
5. Kinsella MT, Biltoft JM, Marez H, Glaser D, Kwong N, Restrepo C. Improving mortality from severe sepsis by implementation of surviving sepsis guidelines at a community teaching hospital. Crit Care Med 2006;34:A109

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