Timing of Core Sepsis Bundle Elements Initiation in Critically Ill Patients: A Multicenter Target Trial Emulation Study - PubMed
6 hours ago
- #Sepsis Management
- #ICU Timing
- #Target Trial Emulation
- One-hour sepsis bundle introduced in 2018, but optimal timing for antibiotics, fluids, and vasopressors in ICU settings is debated.
- Multicenter target trial emulation study used retrospective data from MIMIC-IV and Chinese ICU cohorts to compare initiation within 0-1 hour vs. 1-3 hours.
- Antibiotic initiation within 1 hour was associated with lower 28-day mortality and earlier ICU discharge compared to 1-3 hours.
- Fluid resuscitation within 1 hour, delivering ≥30 mL/kg crystalloid within 3 hours, linked to lower mortality and earlier discharge.
- Vasopressor initiation within 1 hour showed no survival benefit or reduction in time to ICU discharge.
- Findings consistent across sensitivity analyses and when comparing with a 1-6 hour window.
- Conclusion emphasizes timely antibiotics and fluids for improved survival, not vasopressors, informing future sepsis guidelines.