Does the SEP-1 Bundle Improve Survival in Sepsis?
In one single-center observational study, lower in-hospital mortality was reported after the implementation of the SEP-1 bundle.
HealthDay News — For adults with sepsis, use of the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) or its hemodynamic interventions is not associated with improved survival, according to a review published in the Annals of Internal Medicine.
Dominique J. Pepper, MBChB, MD, from the National Institutes of Health in Bethesda, MD, and colleagues conducted a systematic review to examine whether moderate- or high-level evidence shows that use of the entire SEP-1 bundle or its hemodynamic interventions (including serial lactate measurements; a fluid infusion of 30 mL/kg of body weight; and assessment of volume status and tissue perfusion with a focused examination, bedside cardiovascular ultrasonography, or fluid responsiveness testing) improves survival among adults with sepsis. Twenty studies met the inclusion criteria.
The researchers found that in one single-center observational study, lower in-hospital mortality was reported after implementation of the SEP-1 bundle. Increased survival was seen with serial lactate measurement or 30-mL/kg fluid infusions based on data from 16 studies (2 randomized and 14 observational). Of the 17 studies, none were free of confounders or at low risk of bias. Fluid responsiveness testing did not alter survival in 3 randomized trials.
"No high- or moderate-level evidence shows that SEP-1 or its hemodynamic interventions improve survival in adults with sepsis," the authors wrote.
Pepper DJ, Jaswal D, Sun J, et al. Evidence underpinning the US government-mandated hemodynamic interventions for sepsis: a systematic review [published online February 20, 2018]. Ann Intern Med. doi: 10.7326/M17-2947