What is sepsis, in the terms the medical records use?

Sepsis is defined by international consensus as life-threatening organ dysfunction caused by a dysregulated host response to infection. That definition comes from the Third International Consensus Definitions, published in JAMA in 2016 and known universally as Sepsis-3. Clinically, organ dysfunction is represented by an increase of two or more points in the Sequential Organ Failure Assessment (SOFA) score, a threshold associated with in-hospital mortality above 10 percent. Septic shock is a subset of sepsis in which circulatory and cellular or metabolic abnormalities are severe enough to substantially increase mortality: patients are identified clinically by needing a vasopressor to maintain a mean arterial pressure of 65 mm Hg or greater together with a serum lactate above 2 mmol/L in the absence of hypovolemia. That combination carries in-hospital mortality above 40 percent. Sepsis-3 also concluded that the older term “severe sepsis” was redundant, which is why you will see it in older charts but not in current guidance.

What is the 1-hour sepsis bundle?

In 2018 the Surviving Sepsis Campaign collapsed its older 3-hour and 6-hour bundles into a single Hour-1 bundle, published by Levy, Evans and Rhodes. It calls for five things to be begun within one hour of time zero — meaning triage in the emergency department, or the moment of sepsis recognition on a ward: measure lactate, draw blood cultures before antibiotics, give broad-spectrum antibiotics, begin 30 mL/kg of crystalloid for hypotension or a lactate of 4 mmol/L or more, and start vasopressors if the patient stays hypotensive during or after fluid resuscitation. The word doctors and defense experts will emphasize is “begun.” The Hour-1 bundle asks that these be initiated within the hour, not completed within it.

What are the 3-hour and 6-hour bundles?

Those come from a different instrument, and conflating the two is one of the most common errors in this area. The Centers for Medicare and Medicaid Services maintains a quality measure called SEP-1, the Severe Sepsis and Septic Shock Early Management Bundle. Within three hours of time zero it requires clinicians to measure lactate, draw blood cultures, administer broad-spectrum antibiotics, and infuse 30 mL/kg or more of intravenous crystalloids for patients with hypotension or a lactate of 4.0 mmol/L or greater. Within six hours, for septic shock, it requires repeat lactate measurement if the initial lactate was above 2.0 mmol/L, initiation of vasopressors, and documentation of a repeat volume status and tissue perfusion assessment. Time zero under SEP-1 is the first moment at which documentation of suspected or confirmed infection, systemic inflammatory response criteria, and acute organ dysfunction all appear within a six-hour window — a definition that is itself contested, and which researchers have found produces high rates of disagreement between reviewers.

So which clock applies to my case?

It depends on the year of the care, on whether the patient was in shock, and on what the hospital's own protocol said — and the honest answer is that this is a question for a retained expert, not for a website. As a practical matter three separate frameworks are in play. The Surviving Sepsis Campaign's Hour-1 bundle from 2018 sets a one-hour initiation target. CMS SEP-1 sets the 3-hour and 6-hour targets, and since fiscal year 2026 it is no longer merely a reporting measure — it now affects hospital payment through the Hospital Value-Based Purchasing Program, which means hospitals have a direct financial stake in their own compliance data. And the 2026 Surviving Sepsis Campaign guidelines, which replaced the 2021 edition in March 2026, set the current clinical recommendations: antimicrobials immediately and ideally within one hour for septic shock and for probable or definite sepsis (both strong recommendations), but within three hours from first suspicion where sepsis is only possible and the patient is not in shock (a conditional recommendation). A hospital's own internal sepsis protocol is often the most important document of all, because it is the standard the institution set for itself.

What are the signs of end-organ dysfunction in sepsis?

Organ dysfunction is what separates sepsis from an ordinary infection, and it is scored across six systems. The brain shows altered mental status — confusion, agitation, lethargy, a falling Glasgow Coma Scale. The lungs show hypoxemia, classically a PaO2 to FiO2 ratio below 300, increasing oxygen requirements, or the need for ventilation. The cardiovascular system shows hypotension that does not correct with fluids and a requirement for vasopressors. The kidneys show falling urine output — oliguria or anuria — with rising creatinine, and sometimes a need for dialysis. The liver shows a rising bilirubin, with a total bilirubin above 4 mg/dL a commonly cited marker. Coagulation shows a falling platelet count, below 100,000 per microlitre, and a rising INR above 1.5 or PTT above 60 seconds. Across all of them sits lactate above 2 mmol/L as a marker of tissue hypoperfusion. In a malpractice case these matter twice over: they establish that sepsis was present, and because they are nearly all laboratory values with timestamps, they let you reconstruct hour by hour what the treating team could see and when.

What are the early and late signs of septic shock?

Early shock is compensated, and it is often called warm shock. The body maintains blood pressure by increasing cardiac output while the blood vessels dilate, so the patient looks warm and flushed, with bounding pulses, very fast capillary refill, a racing heart and rapid breathing. Blood pressure at this stage may still be entirely normal. Late shock is decompensated, and is called cold shock. Compensation fails, cardiac output falls, and the body shunts blood away from the skin and extremities: the patient becomes cool, pale or mottled, capillary refill slows past three seconds, pulses become thready, urine output falls, mental status declines, and blood pressure finally drops. The single most important point for a legal case is this: hypotension is a late sign, not an early one. This is emphasized particularly in children, who compensate extremely well and then crash. A normal blood pressure does not rule out shock, and a chart showing normal blood pressures alongside tachycardia, tachypnea, delayed capillary refill and altered mentation is not a reassuring chart.

If the hospital did not follow the sepsis guidelines or missed the bundle, is that automatically negligence?

No, and this is the most common misunderstanding about these cases. Oregon states the standard of care in ORS 677.095: a physician has the duty to use that degree of care, skill and diligence that is used by ordinarily careful physicians in the same or similar circumstances in the community of the physician or a similar community. The statute says nothing about guidelines, bundles or quality measures, and nothing about how the standard is proved. What a guideline provides is powerful evidence of what ordinarily careful practitioners do, and a missed bundle element usually demands an explanation — but the standard itself is established through expert testimony. That requirement comes from Oregon case law rather than from any statute, and Oregon has no certificate-of-merit or affidavit-of-merit filing requirement of the kind many other states impose. Two further cautions. SEP-1 is a payment and quality measure, not a standard of care, and the 2026 guidelines themselves grade several of these elements as conditional rather than strong — including the 30 mL/kg fluid volume. Since January 2022 SEP-1 has allowed a physician to give a different volume if they document the amount and the reason. Expect a defense expert to make all of those points.

Where does sepsis care most often go wrong?

The recurring patterns are recognition, escalation and follow-through rather than exotic clinical judgment. A patient presents with an infection and abnormal vital signs that are charted and not acted on. A source of infection is identified but never controlled — an abscess not drained, an infected line not pulled, an obstruction not relieved. Antibiotics are ordered but not administered for hours, or an empiric choice misses the likely organism and is never revisited when cultures and sensitivities return. A deteriorating patient is not escalated to a higher level of care, or a shift-change handoff loses the trajectory while everyone looks at the latest single number. A patient is discharged from an emergency department while still meeting screening criteria and returns in shock. What these have in common is that the information needed to act was already in the record.

Does it change anything if the hospital was OHSU or a county hospital?

Substantially, and in ways that can end a claim before anyone has finished collecting records. A claim against an Oregon public body runs through the Oregon Tort Claims Act, which requires written notice of claim before suit: under ORS 30.275, within one year after the alleged loss or injury for wrongful death, and within 180 days for all other claims, with the action itself to be commenced within two years. Those notice periods are subject to a discovery rule — under Stephens v. Bohlman, 314 Or 344 (1992), the wrongful death notice period runs from a reasonable opportunity to discover the injury and the identity of the party responsible, not automatically from the date of death. Damages work differently too. The $500,000 wrongful death noneconomic cap in ORS 31.710 does not apply here at all: subsection (1) expressly excepts claims subject to the Tort Claims Act, and excepts claims subject to workers' compensation on the same terms. Instead the Act's own liability limits control, and which set applies turns on the defendant — ORS 30.271(5) provides that the state limits apply to claims against Oregon Health and Science University, while ORS 30.272(5) provides that the local public body limits do not. Identifying the right defendant in the first weeks matters more here than almost anywhere else in Oregon injury practice.

Medical Malpractice — Subtopic

Oregon Sepsis Malpractice Lawyer

Q: What is qSOFA, and why does it matter in a malpractice case?

qSOFA is a three-item bedside screen introduced by Sepsis-3 for patients outside the intensive care unit — in an emergency department, on a general ward, or before arrival at hospital. A patient with suspected infection is flagged as more likely to have the poor outcomes typical of sepsis when at least two of three criteria are present: a respiratory rate of 22/min or greater, altered mentation, or a systolic blood pressure of 100 mm Hg or less. It matters in these cases because all three are cheap, fast, and already recorded in nearly every set of vital signs taken. When a chart shows them documented and then shows hours passing with no reassessment and no escalation, the record itself has raised the question the lawsuit will be about.

Q: How long do I have to bring an Oregon sepsis claim?

For a patient who survives, ORS 12.110(4) requires the action to be commenced within two years from the date when the injury is first discovered or in the exercise of reasonable care should have been discovered, and in no event more than five years from the treatment, omission or operation. The two-year clock starts when you knew or should have known the doctor was negligent — not when you found out you were hurt. Under Gaston v. Parsons, 318 Or 247 (1994), “injury” in that subsection means the harm, its cause, and the negligence together. The five-year repose has one exception: where no action was commenced within five years because of fraud, deceit or misleading representation, suit may be brought within two years of discovering that fraud, deceit or misleading representation. Where the sepsis was fatal, the claim is a wrongful death action under ORS 30.020, brought by the personal representative of the estate, and it must be commenced within three years after the injury causing the death is discovered or reasonably should have been discovered — and in no case later than the earliest of three years after the death or the longest applicable statute of ultimate repose. It is not simply three years from the date of death.

Sepsis kills by the hour, and in most of these cases the information needed to act was already in the chart. Abnormal vital signs get recorded and not acted on; antibiotics are ordered and not given; a deteriorating patient is not escalated. Oregon's two-year limitation for a surviving patient runs under ORS 12.110 from discovery, with a five-year repose behind it. Where sepsis was fatal, the claim is a wrongful death action under ORS 30.020. And if the care came from a public hospital, the Oregon Tort Claims Act notice deadline under ORS 30.275 can expire long before anyone has finished obtaining the records.

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What sepsis is, in the terms the records use

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. That is the definition adopted by the Third International Consensus Definitions in 2016 — Sepsis-3 — and it is the vocabulary the medical records in your case will be written in. Organ dysfunction is represented clinically by an increase of two or more points in the Sequential Organ Failure Assessment score, a threshold associated with in-hospital mortality above 10 percent.

Septic shock is the subset in which circulatory and cellular or metabolic abnormalities are severe enough to substantially increase mortality. Patients are identified clinically by a need for a vasopressor to maintain a mean arterial pressure of 65 mm Hg or greater, together with a serum lactate above 2 mmol/L, in the absence of hypovolemia. That combination carries in-hospital mortality above 40 percent. Sepsis-3 also retired the phrase “severe sepsis” as redundant, which is why it turns up in older charts and not in current guidance.

The screen that matters most in a malpractice case is qSOFA, because it is assembled entirely from things that are already being written down. Outside the intensive care unit, a patient with suspected infection is flagged when at least two of three are present: a respiratory rate of 22/min or greater, altered mentation, or a systolic blood pressure of 100 mm Hg or less. When those appear in a chart and the next several hours contain nothing, the record has already framed the question the case will turn on.

Two updates are worth knowing, because they date a case file. In December 2025 the SOFA score itself was revised for the first time in three decades, as SOFA-2 — the same six organ systems, with new variables and new thresholds. And for children, the 2005 pediatric consensus criteria were replaced in 2024 by the Phoenix criteria, under which a Phoenix score of 2 or more in a child with suspected infection is sepsis, and sepsis plus a cardiovascular point is septic shock. An expert report still working from the superseded instruments is a report worth reading closely.

The clock: 1 hour, 3 hours, 6 hours

Almost every sepsis case turns on time. What confuses people — including lawyers, and sometimes including the hospital — is that there is no single sepsis clock. There are several instruments, they were written by different bodies for different purposes, and they do not say the same thing. Treating the CMS quality measure as though it were the clinical standard, or the other way round, is the fastest way to get a sepsis case wrong.

Instrument	Window	Elements	Time zero	What it actually is
SSC Hour-1 bundle (2018)	Begin within 1 hour	Measure lactate; draw blood cultures before antibiotics; give broad-spectrum antibiotics; begin 30 mL/kg crystalloid for hypotension or lactate ≥ 4 mmol/L; start vasopressors if hypotensive during or after fluids.	Triage in the ED, or the moment of sepsis recognition.	Clinical bundle. Elements initiated, not completed, within the hour.
CMS SEP-1 — 3-hour	Within 3 hours	Measure lactate; draw blood cultures; administer broad-spectrum antibiotics; infuse ≥ 30 mL/kg IV crystalloid for hypotension or lactate ≥ 4.0 mmol/L.	First moment infection, SIRS criteria and acute organ dysfunction are all documented within a 6-hour window.	Federal payment and quality measure — not a standard of care. Affects hospital payment through Hospital VBP from FY2026.
CMS SEP-1 — 6-hour	Within 6 hours	For septic shock: repeat lactate if the initial value was > 2.0 mmol/L; initiate vasopressors; document a repeat volume status and tissue perfusion assessment.	Same time zero as the 3-hour element.	Same measure; the septic-shock half of it.
SSC 2026 guidelines	1 hour or 3 hours, by category	Antimicrobials immediately and ideally within 1 hour for septic shock, and within 1 hour for probable or definite sepsis (both strong). Within 3 hours of first suspicion where sepsis is only possible and there is no shock (conditional). Blood cultures as soon as possible and ideally before antimicrobials, without delaying them. At least 30 mL/kg crystalloid in the first 3 hours for sepsis-induced hypoperfusion (conditional).	Recognition, or the time sepsis was first suspected.	Current clinical guideline. Replaced the 2021 edition in March 2026.

Three things follow from that table, and all three tend to decide cases. First, the Surviving Sepsis Campaign folded its own older 3-hour and 6-hour bundles into the single Hour-1 bundle in 2018, so when a record or a protocol refers to “the 3-hour bundle” it is usually referring to the CMS measure, not to the Campaign. Second, SEP-1 is a payment measure. Since fiscal year 2026 it feeds the Hospital Value-Based Purchasing Program, which means the hospital has a financial stake in how its own compliance is recorded — a fact worth knowing before you accept its abstracted data at face value. Third, the 2026 guidelines are more granular than any bundle: the one-hour antimicrobial target is a strong recommendation for septic shock and for probable or definite sepsis, but only a conditional three-hour target where sepsis is merely possible and there is no shock.

The fluid element deserves its own warning. The 30 mL/kg crystalloid figure appears in all of these instruments, but the 2026 guidelines grade it as conditional rather than strong, and since January 2022 SEP-1 has permitted a physician to give a different volume provided they document the volume and the reason. A case built on the premise that 30 mL/kg is a fixed requirement will meet a defense expert holding the guideline that says otherwise.

Signs of end-organ dysfunction and failure

Organ dysfunction is what separates sepsis from an ordinary infection, and it is what the SOFA score measures across six systems. For a lawyer these signs matter twice over. They establish that sepsis was present. And because nearly all of them are laboratory values and recorded observations carrying timestamps, they let you reconstruct, hour by hour, what the treating team could see at the moment each decision was made.

Brain / neurologic

Altered mental status — confusion, agitation, lethargy, a falling Glasgow Coma Scale. Often the earliest dysfunction, and often charted by a nurse before anyone else acts on it.

Respiratory

Hypoxemia, classically a PaO₂/FiO₂ ratio below 300. Rising oxygen requirement, tachypnea, and ultimately the need for mechanical ventilation.

Cardiovascular

Hypotension that does not correct with fluid resuscitation, and a requirement for vasopressors to hold a mean arterial pressure of 65 mm Hg.

Kidney

Falling urine output — oliguria, then anuria — with rising creatinine and pre-renal azotemia. In severe cases, a need for renal replacement therapy.

Liver

Rising bilirubin; a total bilirubin above 4 mg/dL is a commonly cited marker of hepatic dysfunction in sepsis.

Coagulation / hematologic

Thrombocytopenia, with platelets below 100,000 per microlitre, and coagulopathy — INR above 1.5 or PTT above 60 seconds. In the extreme, disseminated intravascular coagulation.

Metabolic (across systems)

Lactate above 2 mmol/L as a marker of tissue hypoperfusion — the number that appears in nearly every bundle, and the one whose absence from a chart is itself telling.

Multiple organ dysfunction syndrome is the end of that road — two or more systems failing at once, with mortality rising sharply as each is added. When it appears in a chart, the question the case asks is almost always how many hours of documented single-organ dysfunction came before it, and what was done during them.

Septic shock: the early signs and the late ones

Septic shock does not begin with low blood pressure. It ends with it. That single fact is responsible for a large share of the missed-sepsis cases we see, and it is the reason a chart full of normal blood pressures is not the defense it first appears to be.

Early — compensated, “warm” shock

The blood vessels dilate and the heart compensates by driving cardiac output up. The patient is warm and flushed to the touch, with bounding peripheral pulses and capillary refill that is unusually fast rather than slow. Heart rate and respiratory rate climb. Mental status may already be subtly off. Urine output begins to fall.

Blood pressure at this stage is frequently still normal.

This is the window in which the outcome is usually still recoverable, and it is therefore the window the case is really about.

Late — decompensated, “cold” shock

Compensation fails. Cardiac output falls, catecholamines drive peripheral vascular resistance up, and blood is shunted away from the skin and the extremities. The patient turns cool, pale or mottled. Capillary refill stretches past three seconds and pulses become thready. Urine output drops away, mental status declines, lactate climbs, and blood pressure finally falls.

Hypotension here is a late and ominous finding, not a first warning.

By the time it appears, organ injury is usually already underway.

This progression is emphasised most strongly in children, who compensate extraordinarily well and then deteriorate very fast; in pediatric practice hypotension is treated as a late and ominous sign. The same physiology operates in adults, and it is the reason the qSOFA screen deliberately sets its blood-pressure threshold at a systolic of 100 mm Hg rather than waiting for a formally hypotensive reading. A chart showing tachycardia, tachypnea, delayed capillary refill and altered mentation alongside a normal blood pressure is not a reassuring chart. It is a description of compensated shock.

The clinical standards — and what they are not

Sepsis is among the most heavily guidelined conditions in medicine, and the whole authority set turned over recently. The Surviving Sepsis Campaign replaced its 2021 adult guidelines in March 2026 and its 2020 pediatric guidelines in the same cycle. The American Heart Association updated both Advanced Cardiovascular Life Support and Pediatric Advanced Life Support in October 2025. The SOFA score was revised in December 2025. Every one of those documents is cited in full at the bottom of this page, and any analysis of a sepsis case resting on the older editions should be checked against the current ones.

Here is the part that is routinely got wrong, including by lawyers. A clinical guideline is not the legal standard of care in Oregon, and neither is a federal quality measure. ORS 677.095 states the duty: a physician has the duty to use that degree of care, skill and diligence that is used by ordinarily careful physicians in the same or similar circumstances in the community of the physician or a similar community. The statute says nothing about guidelines, bundles or measures, and nothing about how the standard is proved. The requirement of expert testimony comes from Oregon case law rather than from statute, and Oregon imposes no certificate-of-merit or affidavit-of-merit filing requirement of the kind many other states do.

What that means in practice is straightforward. A missed bundle element is strong evidence and usually demands an explanation, but it is not negligence by itself, and a defense expert will say so — particularly where the guideline itself grades the element as conditional. Equally, a hospital that recorded full bundle compliance is not thereby safe if the care was unreasonable in the circumstances, and its compliance data is its own work product. The guideline opens the conversation. An expert closes it.

The Oregon deadlines that decide these cases

Where the patient survives, ORS 12.110 subsection (4) requires the action to be commenced within two years from the date when the injury is first discovered or in the exercise of reasonable care should have been discovered, and in no event more than five years from the treatment, omission or operation. The two-year clock starts when you knew or should have known the doctor was negligent — not when you found out you were hurt. Under Gaston v. Parsons, 318 Or 247 (1994), “injury” in that subsection means the harm, its cause, and the negligence together, which in a sepsis case can be months after the hospital stay ended. The five-year repose has a single exception: where no action was commenced within five years because of fraud, deceit or misleading representation, suit may be brought within two years of discovering it.

Where sepsis was fatal, the claim is a wrongful death action under ORS 30.020, brought by the personal representative of the estate. It must be commenced within three years after the injury causing the death is discovered or reasonably should have been discovered, and in no case later than the earliest of three years after the death or the longest other applicable statute of ultimate repose. It is not simply three years from the date of death. In a private-hospital death case, noneconomic damages are limited to $500,000 by ORS 31.710, which since its 2021 amendment reaches wrongful death claims only. Two categories of death claim sit outside it by statute, and both come before any constitutional argument: a claim against a public body, and a claim subject to workers’ compensation — an exclusion wider than it reads, which covers third-party claims brought by or for a worker injured in the course and scope of employment. For a death claim the statute does reach, the cap is the statutory default and remains open to a fact-specific, as-applied constitutional challenge.

If the care was delivered by a public body — OHSU, a county or district hospital, a public health clinic — the Oregon Tort Claims Act applies on top, and it changes both the clock and the money. ORS 30.275 requires written notice of claim within one year after the alleged loss or injury for wrongful death, and within 180 days for all other claims, with the action itself to be commenced within two years. Those notice periods carry a discovery rule: under Stephens v. Bohlman, 314 Or 344 (1992), the wrongful death notice period runs from a reasonable opportunity to discover the injury and the identity of the party responsible for it, not automatically from the date of death.

The damages analysis changes as well, and in a way that is easy to get backwards. The $500,000 wrongful death cap in ORS 31.710 does not apply to a Tort Claims Act case at all — subsection (1) expressly excepts claims subject to the Act. The Act's own liability limits govern instead, and which set applies depends on the defendant: ORS 30.271 subsection (5) provides that the state limits apply to claims against Oregon Health and Science University, while ORS 30.272 subsection (5) provides that the local public body limits do not. For the full framework, see the Oregon Tort Claims Act guide.

The practical point is that the deadline analysis belongs in the first conversation, not the first month. A sepsis death at a public hospital can carry a one-year notice obligation that runs out while the family is still waiting on records.

Frequently asked questions

Sources

The clinical statements on this page come from the following consensus documents, guidelines and studies. Each is linked to its permanent DOI or publisher page so you can read it for yourself. Citation data courtesy of the U.S. National Library of Medicine's PubMed.

Definitions and scoring

Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.Source of the sepsis and septic shock definitions, the SOFA threshold, and the qSOFA criteria.
Ranzani OT, Singer M, Salluh JIF, et al. Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score. JAMA. 2025;334(23):2090-2103.December 2025 revision of the SOFA score after thirty years — same six organ systems (brain, respiratory, cardiovascular, liver, kidney, hemostasis) with new variables and revised thresholds.
Sanchez-Pinto LN, Bennett TD, DeWitt PE, et al. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024;331(8):675-686.The Phoenix criteria, which replaced the 2005 pediatric consensus criteria: a Phoenix score of 2 or more in a child with suspected infection is sepsis; sepsis plus a cardiovascular point is septic shock.

Treatment guidelines

Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med. 2026;52(5):863-936.The current adult guidelines, published March 2026 and co-published in Critical Care Medicine. Supersedes the 2021 edition; 129 statements, 46 of them new.
Publisher Correction: Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med. 2026;52(6):1411-1413.Correction notice to the 2026 adult guidelines — read alongside the guideline itself.
Weiss SL, Peters MJ, Oczkowski SJW, et al. Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026. Intensive Care Med. 2026;52(5):937-983.The current pediatric guidelines, which supersede the 2020 edition: 61 statements, of which five are strong recommendations, 24 conditional and ten good practice statements. The panel reported that only three recommendations rest on high or moderate certainty of evidence — a caution worth carrying into any expert report.
Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 Update. Crit Care Med. 2018;46(6):997-1000.The Hour-1 bundle, which replaced the earlier separate 3-hour and 6-hour Surviving Sepsis Campaign bundles. Also published as Intensive Care Med. 2018;44(6):925-928.
Society of Critical Care Medicine. Surviving Sepsis Campaign adult guidelines and resources.The campaign's own resource page, including bundle materials and infographics.

Resuscitation guidelines

Wigginton JG, Agarwal S, Bartos JA, et al. Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16 suppl 2):S538-S577.ACLS, updated October 2025.
Lasa JJ, Dhillon GS, Duff JP, et al. Part 8: Pediatric Advanced Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16 suppl 2):S479-S537.PALS, updated October 2025; includes the management of shock states in children.
Hirsch KG, Amorim E, Coppler PJ, et al. Part 11: Post-Cardiac Arrest Care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16 suppl 2):S673-S718.Relevant where a septic patient arrests and is resuscitated.
Del Rios M, Bartos JA, Panchal AR, et al. Part 1: Executive Summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16 suppl 2):S284-S312.Overview of the 2025 resuscitation guideline set, which supersedes the 2020 edition.

Quality measures and hospital programs

Rhee C, Yu T, Wang R, et al. Association Between Implementation of the Severe Sepsis and Septic Shock Early Management Bundle Performance Measure and Outcomes in Patients With Suspected Sepsis in US Hospitals. JAMA Netw Open. 2021;4(12):e2138596.Peer-reviewed description of the SEP-1 3-hour and 6-hour elements and of the contested SEP-1 time-zero definition.
Centers for Disease Control and Prevention. Hospital Sepsis Program Core Elements.What CDC expects a hospital sepsis program to include — leadership, accountability, expertise, action, tracking, reporting and education. Useful when the failure is institutional rather than individual.
Gotur DB. Sepsis in a Panorama: What the Cardiovascular Physician Should Know. Methodist Debakey Cardiovasc J. 2018;14(2):89-100.Peer-reviewed summary of the Hour-1 bundle elements and of time zero, used here to corroborate the bundle content.

Talk through a sepsis case

If someone in your family died of sepsis, or survived it with organ damage after a delay, the records usually tell the story. The free case review is a conversation with Todd Huegli, not an intake form — and if a public hospital was involved, the notice clock is already running.

Call 971-317-6436 Free case review