Components of the Paediatric SEPSIS 6 bundle
The Paediatric SEPSIS 6 is a bundle, a set of six actions delivered together, for a child with suspected sepsis, to be completed within the first hour.
Remember
Oxygen comes first: high flow oxygen with continuous monitoring. Then come access with bloods, antibiotics, consideration of fluids, early senior help and early consideration of inotropes (drugs that support the heart), all within the first hour.
The Paediatric SEPSIS 6 is a bundle, meaning a set of actions delivered together, for a child with suspected sepsis. Its six steps should be completed within the first hour. Achieving that gives a better outcome for the child. When all six steps are completed within the first hour, the length of stay in paediatric intensive care or general hospital, and the mortality rate, are reported to be almost halved.
The first step is high flow oxygen, given straight away with continuous monitoring. Monitoring includes pulse oximetry (a probe on the finger that measures oxygen saturation) and cardiac monitoring. It matters because a child compensates for a long time and then collapses suddenly, and it lets the team see deterioration straight away. NICE advises giving oxygen to people under 16 with suspected sepsis if they show signs of shock (failing circulation) or their oxygen saturation is below 92 percent in air.
The second step is to get access, either intravenous (IV) or intraosseous (IO, through the bone), and to take bloods. Access means a cannula in a vein, or a needle in the bone if a vein cannot be found. The third step is IV or IO antibiotics, which go straight into the circulation.
Steps four to six cover fluids, senior clinicians and inotropes. If the child is shocked (their circulation is failing), consider fluid resuscitation with isotonic fluid, repeated if needed. Senior clinicians are involved early, so that these decisions are made by someone experienced. Inotropes are drugs that strengthen the heartbeat and support the circulation, and the bundle asks for early consideration of them in a shocked child. A senior physician should prescribe them.
Key facts
- Step one
- High flow oxygen, given straight away with continuous monitoring.
- Steps two and three
- IV or IO access with bloods, then IV or IO antibiotics.
- Bloods
- These ideally include blood cultures, glucose and lactate.
- Fluids
- If the child is shocked, consider fluid resuscitation with isotonic fluid, repeated if needed.
- Steps four to six
- Consider fluids, involve senior clinicians early and consider inotropic support early.
- Timing
- All six steps should be completed within the first hour.
- Audit
- A UK audit found that 62% of children in septic shock (sepsis with cardiovascular dysfunction) did not get the recommended emergency fluid and inotrope management.
Exam traps
- Steroids are not part of the initial six steps, which start with oxygen and move on to access with bloods, antibiotics, consideration of fluids, early senior help and early consideration of inotropes.
- Imaging to find the source of infection is not the first step, because it comes after resuscitation has begun and would delay treatment of an unstable child.
- Oral antibiotics after cultures return do not fit the bundle, because it uses intravenous or intraosseous antibiotics, given within the first hour.
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