The “Sepsis Six” is a bundle of medical therapies designed to reduce the mortality of patients with sepsis. Early intervention is critical in sepsis management to improve outcomes, and the Sepsis Six provides a straightforward and immediate approach that can be implemented within the first hour of recognizing sepsis.
The Sepsis Six bundle comprises three diagnostic and three therapeutic steps:
Diagnostic Steps:
- Blood cultures:
- Before starting antibiotics, obtain blood samples to identify the causative organism.
- Lactate for acidosis, FBC, U&E, CRP, INR:
- Provides insights into the patient’s physiological response, renal and liver function, electrolyte balance, and other parameters.
- Urine output measurement:
- Either by ensuring a catheter is inserted or measuring output in another way, as renal function can be compromised in sepsis.
Therapeutic Steps:
- Intravenous (IV) antibiotics:
- Administer broad-spectrum antibiotics within 1 hour of sepsis recognition, with adjustments made later based on culture results and clinical status.
- IV fluid resuscitation:
- Provides rapid fluid resuscitation to improve perfusion and organ function (20ml/kg in children if lactate > 2)
- Administer high-flow oxygen:
- To maintain oxygen saturation >94% or >88-92% in patients with risk of hypercapnic respiratory failure.
Implementing the Sepsis Six protocol within the first hour of diagnosing sepsis has been associated with reduced mortality. It offers a structured initial response to a complex condition that requires prompt action. However, individual patient needs may vary, and clinical judgment remains essential.
Further Management
Additional investigations may be performed depending on the suspected infection:
- Chest xray if pneumonia is suspected
- Abdominal and pelvic ultrasound if intra-abdominal infection is suspected
- Lumbar puncture if meningitis is suspected
- Meningococcal PCR blood test if meningococcal disease is suspected
- Serum cortisol if adrenal crisis is suspected