What is the Surviving Sepsis Campaign?
The Surviving Sepsis Campaign is an international, collaborative quality improvement initiative launched in 2002 to reduce sepsis mortality by developing evidence-based clinical practice guidelines and implementing standardized care bundles at the bedside. 1, 2
Origins and Structure
The Campaign was established as a partnership between three major critical care organizations: the European Society of Intensive Care Medicine (ESICM), the International Sepsis Forum (ISF), and the Society of Critical Care Medicine (SCCM). 1, 2 The initiative was formally launched through the "Barcelona Declaration" in October 2002, calling on critical care providers, governments, health agencies, and the public to join the fight against sepsis. 3
The original goal was ambitious: achieve a 25% reduction in the relative risk of death from severe sepsis and septic shock within 5 years through standardized, evidence-based care. 2, 3
Core Components
Evidence-Based Guidelines
The Campaign produces comprehensive clinical practice guidelines through a formal, transparent process involving international experts in sepsis management. 1
- First guidelines published in 2004 (endorsed by 11 professional societies) 1
- Updated in 2008 (involving 18 organizations) 1
- Revised in 2012 with expanded recommendations 1, 4
- Most recent major update in 2016 with 30 international scientific organizations sponsoring 1, 5
Sepsis Bundles
Working with the Institute for Healthcare Improvement, the Campaign translated complex guidelines into actionable "bundles"—simplified sets of time-sensitive interventions that clinicians can implement at the bedside. 1, 6
The Resuscitation Bundle (First 6 Hours): 1, 6
- Measure serum lactate
- Obtain blood cultures before antibiotics
- Administer broad-spectrum antibiotics within 3 hours (ED) or 1 hour (ICU)
- Deliver minimum 20 mL/kg crystalloid for hypotension and/or lactate >4 mmol/L
- Apply vasopressors to maintain MAP ≥65 mmHg if hypotension persists
- Achieve central venous pressure >8 mmHg and central venous oxygen saturation >70% in persistent shock
The Management Bundle (First 24 Hours): 1, 6
- Administer low-dose steroids for septic shock per hospital policy
- Maintain glucose control between normal and <150 mg/dL
- Maintain inspiratory plateau pressures <30 cm H₂O for ventilated patients
Performance Improvement Program
The Campaign established a voluntary, international database and quality improvement initiative where hospitals could track their compliance with bundle elements and monitor outcomes. 1, 4
- Any hospital could participate voluntarily 1
- Sites recruited physician and nurse champions 1
- Secure database application provided for data collection and audit feedback 1
- Regional launch meetings organized for education and implementation 1
Demonstrated Impact
Analysis of over 22,000 patients showed that participation in the Campaign was associated with a 5.4% absolute survival benefit. 2 Hospital mortality decreased from 37% to 30.8% over 2 years in the performance improvement program. 1 The adjusted odds ratio for mortality improved the longer a site participated in the Campaign. 1
Evolution and Current State
The Campaign has evolved from rigid 6-hour and 24-hour bundles to more streamlined protocols. 4, 5 The 2016 guidelines emphasize that sepsis and septic shock are medical emergencies requiring immediate treatment and resuscitation. 1 Modern bundles now focus on 3-hour and 6-hour timeframes with simplified, actionable elements. 4, 5
A free software program for implementing the bundles can be downloaded from the Surviving Sepsis Campaign website (www.survivingsepsis.org). 5
Important Caveats
While the Campaign has achieved global reach and influenced sepsis care worldwide, it has generated controversy. 2 Critics have raised concerns about undue industry influence and resistance to protocolization of care. 2 Additionally, some experts note that many guideline recommendations are not strongly evidence-based, with the major components of early bundles based on limited single-center data. 7
Despite these criticisms, the Campaign represents a historic step for critical care medicine and has fundamentally changed how sepsis is recognized and treated globally. 2, 3 The guidelines are endorsed by professional societies worldwide and are widely regarded as the standard of care for severe sepsis management. 7