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Sepsis Hour-1 Bundle — SSC 2021 Current Protocol

Structured combination of five essential interventions that must be completed within 1 hour of sepsis recognition.

Written by: Saygı Hospital Health Guide Editorial Board
Published: · Last updated:

This content is for general information; please consult your physician for diagnosis and treatment.

References (3)

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What is Sepsis Hour-1 Bundle — SSC 2021 Current Protocol?

Sepsis is a life-threatening organ dysfunction caused by infection (Sepsis-3, 2016). Septic shock is sepsis plus need for vasopressors to maintain MAP ≥65 and lactate >2 mmol/L. The Surviving Sepsis Campaign (SSC) 2021 guideline defines the Hour-1 bundle as 'must be completed within one hour of sepsis recognition'.

Hour-1 bundle (5 components): 1) lactate measurement (repeat at 4-6 h if >2), 2) blood cultures before antibiotics, 3) broad-spectrum antibiotic initiation, 4) 30 mL/kg IV crystalloid for hypotension (SBP <90 or MAP <65) or lactate ≥4 (within first 3 hours), 5) vasopressor (norepinephrine first choice) for fluid-unresponsive hypotension to keep MAP ≥65.

Each hour of delay increases mortality by 4-8% (Seymour 2017, NEJM). Sepsis is time-critical — a 'septic shock code' protocol with coordinated emergency department, ICU, and microbiology services is essential.

Sepsis-recognition tools: qSOFA (prehospital), SIRS criteria, NEWS2 score. In-hospital: suspicion of infection plus SOFA increase ≥2 or qSOFA ≥2 suggests sepsis.

Symptoms

Infection source + systemic response — fever >38 or hypothermia <36, tachycardia, tachypnea, altered mental status
Organ dysfunction — hypotension (shock, oliguria), acute kidney injury, coagulopathy, hyperbilirubinemia, thrombocytopenia, hyperlactatemia
Septic shock — fluid-unresponsive hypotension (MAP <65 after 30 mL/kg), vasopressor requirement, lactate >2 mmol/L
Source-specific features — pneumonia (cough, pleuritic pain), urinary (dysuria, costovertebral tenderness), intra-abdominal (abdominal pain, rebound), skin/soft tissue (cellulitis, necrotizing fasciitis), catheter-related infection
Lactate >2 mmol/L — hypoperfusion marker; >4 very serious, >10 extreme mortality

Risk Factors

Immunosuppression — cancer, chemotherapy, steroids, HIV, transplantation
Chronic diseases — diabetes, CKD, cirrhosis, COPD
Elderly (>65) and very young (infants)
High-risk environment — hospital-acquired infection, central venous catheter, long-term urinary catheter, mechanical ventilation
Resistant microbial agents — MRSA, ESBL, carbapenem-resistant, multi-resistant Pseudomonas/Acinetobacter

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Suspicion of infection + qSOFA ≥2 or SOFA increase ≥2 — initiate the sepsis protocol
  • Activate a sepsis code in the emergency department/ward — multidisciplinary team (physician, nurse, pharmacist, microbiology)
  • No Hour-1 bundle component should be delayed — implement in parallel

Treatment Methods

01
Trigger the sepsis code — rapid assessment, response team assembled, note the time (T0)
02
Lactate — arterial or venous, point-of-care result. >2 indicates hypoperfusion; repeat in 2-4 hours (follow trend)
03
Blood cultures — two separate sites, two bottles each (aerobic + anaerobic), BEFORE antibiotics (as quickly as possible)
04
Antibiotics — broad-spectrum IV, source-directed: community-acquired pneumonia (ceftriaxone + macrolide), urosepsis (ceftriaxone or piperacillin-tazobactam), intra-abdominal (piperacillin-tazobactam or meropenem), hospital-acquired (meropenem + vancomycin ± antipseudomonal)
05
Fluid resuscitation — 30 mL/kg crystalloid (balanced solution preferred: Plasmalyte/Ringer's lactate) within first 3 hours; if hypoperfusion persists, dynamic responsiveness assessment (PLR, SVV)
06
Vasopressor — norepinephrine first choice (0.05-0.5 mcg/kg/min), vasopressin 0.03 U/min added second, epinephrine in refractory cases. Target MAP ≥65. Steroid (hydrocortisone 200 mg/day) in refractory shock

Which Department to Visit?

You can visit our Kardiyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.