Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026

Weiss SL, Peters MJ, Oczkowski SJW, Belley-Cote E, Buysse C, Choong KLM, Deep A, Inwald DP, Flori HR, Kneyber MCJ, Menon K, Murthy S, Nunnally ME, Parker MM, Schlapbach LJ, Oliveira CF, Sorce LR, Agus M, Argent AC, Balamuth F, Bansal A, Bem RA, Brierley J, Burns KEA, Carlton EF, Carrol ED, Carroll CL, Carter MJ, Conlon TW, Daniels R, De Luca D, Di Nardo M, Dulfer K, Faust SN, Fernandez-Sarmiento J, Fitzgerald JC, Hall M, Hsu BS, Javouhey E, Joosten K, Karam O, Kelly SP, Lang HJ, Lee JH, Lemson J, MacLaren G, Manning JC, Mehta N, Morin L, Morrow BM, Nadel S, Nishisaki A, Pong S, Raman S, Randolph AG, Ranjit S, Ray S, Remy KE, Scott HF, Sick-Samuels AC, Souza DC, Swan T, Tibby SM, Valla FV, Watson RS, Wiens MO, Wolf J, Zimmerman JJ, Tissieres P, Kissoon N. 

Pediatr Crit Care Med. 2026 Mar 23. doi: 10.1097/PCC.0000000000003927.  Epub ahead of print. PMID: 41869844. 

Abstract

Objectives: To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock.

Design: A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads as well as within subgroups, served as an integral part of the guideline development process.

Methods: New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation but the panel felt that some guidance based on practice patterns may be appropriate.

Results: The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but, for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence.

Conclusions: Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.

Keywords: Surviving Sepsis Campaign; evidence-based medicine; guidelines; infection; pediatrics; sepsis; septic shock.

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