Severe sepsis and septic shock are major problems in critically ill patients.

In the
recent European Sepsis Occurrence in Acutely ill Patients study, which collected
data on septic adult patients in 198 intensive care units (ICUs) from 24 European
countries, ICU mortality was 32% for patients with severe sepsis and 54% when
septic shock was present. Recent guidelines provided by the Surviving Sepsis
Campaign (SSC) provide an important tool for the management of patients with
severe sepsis and septic shock. The next phase of the SSC involves the practical
application of the guidelines and assessment of their effectiveness in improving
outcomes, with the final aim being able to decrease the relative mortality from
sepsis by 25% over 5 years. For this purpose, and to simplify the complex
application of the guidelines, the concept of the sepsis bundle has been
developed ,a bundle being a group of interventions related to a disease
process that, when executed together, result in better outcomes than when
implemented individually. Two bundles have currently been proposed: a 6 hour
resuscitation bundle and a 24-hour management bundle
A recent study by Gao et al showed that compliance with the 6-hour sepsis
bundle was associated with a more than 2-fold decrease in hospital mortality
(49% vs 23%), and compliance with the 24-hour bundle showed a trend to
reduced mortality; however, compliance with both bundles was not very high
(52% for the 6-hour bundle and 30% for the 24-hour bundle). These results raise
several important questions. First, what compliance rates can be achieved for
each bundle? Second, is it possible to reduce the time delays for the various
bundle components, and if so, does it make a difference? Third, do some
interventions affect the feasibility of the bundles more than others do? The aim
of this study was to evaluate whether the bundle approach to sepsis
management is reliable and easy to implement in a large department of
intensive care, and if its implementation can have an impact on outcome. We
also investigated the feasibility of individual interventions and whether earlier
application of some interventions may be associated with improved outcomes.