ArticleCritical care medicine2018
Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients With Severe Sepsis and Septic Shock.
Article in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07179276 (Veno-arterial Carbon Dioxide Partial Pressure Difference), which is not on this map. Cited by 96 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Veno-arterial Carbon Dioxide Partial Pressure Difference (CO2gap) for Early Resuscitation of Septic Shock: A Multicenter Prospective Randomized Trial (CARBON)
Who cites it
96 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Timing of antibiotic initiation in sepsis and neutropenic fever.Frontiers in medicine · 2025Pooled it
- Early Prediction of Sepsis in the ICU Using Machine Learning: A Systematic Review.Frontiers in medicine · 2021Pooled it
- Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation.BMJ open · 2020Trial
- Inverse Correlation Between Plasma Sphingosine-1-Phosphate and Ceramide Concentrations in Septic Patients and Their Utility in Predicting Mortality.Shock (Augusta, Ga.) · 2019Trial
- Inter-clinician diagnostic agreement of shock etiology: a multicenter observational study.Health information science and systems · 2026Article
- Multiple organ dysfunction syndrome: molecular mechanisms and therapeutic strategies.Signal transduction and targeted therapy · 2026Review
- The LncRNA MIAT acts as a sponge for miR-942-5p to exacerbate the inflammation and oxidative stress in macrophages during sepsis-associated liver injury.BMC immunology · 2026Article
- Assessing nurses' knowledge and confidence in adult sepsis: evidence from two hospitals in eastern China.Scientific reports · 2026Article
- Predictors of ICU mortality in septic patients in a resource-limited African setting: a prospective multicenter cohort study in Lubumbashi, DRC.Journal of anesthesia, analgesia and critical care · 2026Article
- Rapid Molecular Diagnostics for Bloodstream Infection in Patients with Chronic Kidney Disease.Diagnostics (Basel, Switzerland) · 2026Review
- The Impact of Evaluation Strategy on Sepsis Prediction Model Performance Metrics in Intensive Care Data: Retrospective Cohort Study.Journal of medical Internet research · 2026Observational
- From feedback to action: a process evaluation of implementation strategies for sepsis bundles in emergency departments.Frontiers in medicine · 2026Article
- Protective role of mucosa-associated invariant T cells in sepsis-related liver injury.Frontiers in immunology · 2026Article
- A Machine Learning-Based Prognostic Model for Sepsis-Associated Liver Injury Using Routine Indicators.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2026Article
- Early risk stratification of sepsis-related liver injury via machine learning: a multicohort study.Frontiers in medicine · 2026Article
- Interpretable machine learning models for predicting New-onset acute organ injury within 48 hours of admission in patients with community-acquired acute cholangitis.Frontiers in medicine · 2026Article
- Nurses' knowledge, attitudes, and decision-making related to sepsis assessment and management in Palestinian intensive care units.BMC nursing · 2025Article
- A novel scoring system for evaluating mortality risk of patients with sepsis during early hospitalization.BMC infectious diseases · 2025Article
- Evaluation of the Diagnosis and Antibiotic Therapy of Sepsis in the Emergency Department: A Retrospective Observational Study.Biomedicines · 2025Article
- The Association Between Time to Completion of at Least 30 mL/kg and Hospital Outcomes Among Patients With Septic Shock.Critical care explorations · 2025Article
36 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
objectivesTo specify when delays of specific 3-hour bundle Surviving Sepsis Campaign guideline recommendations applied to severe sepsis or septic shock become harmful and impact mortality.
designRetrospective cohort study.
settingOne health system composed of six hospitals and 45 clinics in a Midwest state from January 01, 2011, to July 31, 2015. PATIENTS: All adult patients hospitalized with billing diagnosis of severe sepsis or septic shock.
interventionsFour 3-hour Surviving Sepsis Campaign guideline recommendations: 1) obtain blood culture before antibiotics, 2) obtain lactate level, 3) administer broad-spectrum antibiotics, and 4) administer 30 mL/kg of crystalloid fluid for hypotension (defined as "mean arterial pressure" < 65) or lactate (> 4). MEASUREMENTS AND MAIN
resultsTo determine the effect of t minutes of delay in carrying out each intervention, propensity score matching of "baseline" characteristics compensated for differences in health status. The average treatment effect in the treated computed as the average difference in outcomes between those treated after shorter versus longer delay. To estimate the uncertainty associated with the average treatment effect in the treated metric and to construct 95% CIs, bootstrap estimation with 1,000 replications was performed. From 5,072 patients with severe sepsis or septic shock, 1,412 (27.8%) had in-hospital mortality. The majority of patients had the four 3-hour bundle recommendations initiated within 3 hours. The statistically significant time in minutes after which a delay increased the risk of death for each recommendation was as follows: lactate, 20.0 minutes; blood culture, 50.0 minutes; crystalloids, 100.0 minutes; and antibiotic therapy, 125.0 minutes.
conclusionsThe guideline recommendations showed that shorter delays indicates better outcomes. There was no evidence that 3 hours is safe; even very short delays adversely impact outcomes. Findings demonstrated a new approach to incorporate time t when analyzing the impact on outcomes and provide new evidence for clinical practice and research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.