Table 4.

Comparison of surviving sepsis campaign performance improvement indicators/bundles (2012 vs. 2016)

Sepsis bundle 2012 guideline	Sepsis bundle 2016 guideline
Severe sepsis 3-h resuscitation bundle 1. Measure lactate level 2. Obtain blood cultures prior to administration of antibiotics 3. Administer broad spectrum antibiotics 4. Administer 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L	Severe sepsis 3-h resuscitation bundle Same as previous guideline
6-h septic shock bundle 5. Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation to maintain a MAP ≥65 mmHg) 6. In the event of persistent arterial hypotension despite volume resuscitation (septic shock) or Initial lactate ≥4 mmol/L (36 mg/dl)Measure CVPMeasure ScvO2 7. Remeasure lactate if initial lactate was elevated	6-h septic shock bundle 5. Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65mmHg 6. In the event of persistent hypotension after initial fluid administration (MAP< 65 mm Hg) or if initial lactate was ≥4 mmol/L, re-assess volume status and tissue perfusion and document findings according to below Table. Document reassessment of volume status and tissue perfusion with Either Repeat focused exam (after initial fluid resuscitation) including vital signs, cardiopulmonary, capillary refill, pulse, and skin findings Or two of the following Measure CVP Measure ScvO2 Perform bedside cardiovascular ultrasound Perform dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge 7. Re-measure lactate if initial lactate elevated

SSC: Surviving sepsis campaign, MAP: Mean arterial pressure, CVP: Central venous pressure, ScvO2: Central venous oxygen saturation