Association between 1-h bundle and clinical outcomes in patients with sepsis: A systematic review and meta-analysis.

OBJECTIVES

To conduct a systematic review and meta-analysis to compare the impact of the 1-h bundle and non-1-h bundle on clinical outcomes in patients with sepsis.

METHODS

PubMed, Ovid, Cochrane Library, and Web of Science were searched to identify studies comparing the 1-h and non-1-h bundles in sepsis patient. The search strategy was based on a combination of Medical Subject Heading terms and text words. The primary outcome was short-term mortality, including in-hospital, 28-day, and 30-day mortality.

RESULTS

Ten studies (nine observational, one randomized trial) with 4435 patients were included. Overall mortality rates were 20.8 % in the 1-h bundle group and 24.7 % in the non-1-h bundle group. The meta-analysis showed that the 1-h bundle significantly reduced short-term mortality (95 % confidence interval [CI] 0.69-0.84). This effect was consistent across single-center (95 % CI 0.67-0.84) and multicenter studies (95 % CI 0.65-0.95). The mortality benefit was also pronounced in prospective studies (95 % CI 0.61-0.86) and ICU settings (95% CI 0.63-0.80), but not in retrospective studies (95 % CI 0.63-1.02) or emergency department settings (95 % CI 0.71-1.05). The limited number of randomized trials resulted in low certainty of evidence.

CONCLUSIONS

Compliance with the 1-h bundle has the potential to reduce short-term mortality in sepsis patients, particularly in ICU settings. High-quality trials are needed to further validate these findings, especially in emergency department settings.

IMPLICATIONS FOR CLINICAL PRACTICE: Based on this study, critical care providers, including nurses, should consider implementing the 1-h bundle as part of their standard care protocols for sepsis patients, especially in the ICU. This could lead to improved patient outcomes and reduced mortality. Nurses play a crucial role in the early recognition and management of sepsis, and their adherence to the 1-h bundle can significantly impact patient care.