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

The Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock in Children 2026 provide guidance on the identification and management of sepsis in pediatric patients with sepsis based on Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This executive summary reviews the history, methodology, content, and major changes since the 2020 guidelines. HISTORY AND SPONSORSHIP OF THE GUIDELINES The first Surviving Sepsis Campaign (SSC) guidelines specific to pediatrics were published in 2020 as a joint effort of the Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) (1). The 2026 guidelines are an update from 2020 and focus on evidence published through July 2024 with key studies added if published later and identified by the panelists during the final evidence review. Studies that used either the 2005 severe sepsis or septic shock criteria, the 2024 Phoenix sepsis or septic shock criteria, or a more general definition of severe infection leading to life-threatening organ dysfunction were included in the evidence review. These guidelines were funded by SCCM and ESICM with methodological support by the Guidelines in Intensive Care Development and Evaluation group. In addition, 14 professional societies have either sponsored or endorsed these guidelines. There was no industry funding. Details about selection of the 68-person panel and the management of conflict of interests are detailed in the full guidelines document. METHODOLOGY Evidence Synthesis Population, Intervention, Control, and Outcome (PICO) questions addressed in the 2020 guidelines were reviewed for continued relevance, and new PICO questions were developed with input from each subgroup. Only PICO questions that were specific to sepsis or septic shock and determined likely to have substantial new evidence published on the topic were included. Individual studies were assessed for risk of bias using the Cochrane Risk of Bias-2 tool or the Clinical Advances through Research and Information Transfer (CLARITY) Risk of Bias tool for randomized controlled trials or cohort studies, respectively (2,3). We used the GRADE methodology to rate the certainty of evidence as high, moderate, low, or very low considering the risk of bias, inconsistency, indirectness, imprecision, publication bias, of the total available evidence (4–8). The panel considered evidence for each PICO question in a hierarchy of indirectness. Studies focusing on children with sepsis or septic shock were prioritized, although studies inclusive of more general pediatric populations (all PICU patients) were considered on a case-by-case basis. Evidence synthesized for the concurrent adult SSC guideline was considered according to an a priori framework to determine appropriateness of including indirect evidence (Fig. 1). Evidence from adult studies was generally downgraded due to the indirectness of the evidence.Figure 1.: Framework to determine the appropriateness of using indirect evidence from studies of children without sepsis or from adults.Types of Recommendation Statements Recommendations were specified as strong or conditional (previously referred to a “weak” recommendations in prior guidelines) as outlined in Table 1. We used the language “we recommend” for strong recommendations and “we suggest” for conditional recommendations. A strong recommendation indicates that most, if not all, individuals in the relevant clinical situation should receive (or avoid) the intervention. In contrast, a conditional recommendation acknowledges that the balance between desirable and undesirable may vary depending on patient values, clinical circumstances, or resource availability. Conditional recommendations may not be universally implementable and are less likely to be suitable for rigid performance metrics or enforcement. Flexibility and local context should guide their adaptation into policy. Good practice statements (GPSs) were developed in accordance with GRADE guidance when the panel judged unequivocal benefit (or harm) was present but there was an absence of direct evidence. Where there was insufficient evidence to formulate a recommendation, but the panel felt that some guidance based on current practice patterns may be appropriate, we issued an “in our practice” statement summarizing the results of the panel’s practice. We required a minimum 75% response rate and 80% agreement among eligible panelists for all statements to be included in these guidelines. TABLE 1. - Types of Recommendation Statements and Implications of the Strength of Recommendation Category Strength Quality of Evidence Implications to Patients Implications to Clinicians Implications to Policymakers Strong recommendation Strong High or moderate Most individuals in this situation would want the recommended course of action, and only a small proportion would not Most individuals should receive the recommended course of action. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences Can be adapted as policy in most situations, including for use as performance indicators Conditional recommendationa Weak Any The majority of individuals in this situation would want the suggested course of action, but many would not Different choices are likely to be appropriate for different patients, and therapy should be tailored to the individual patient’s circumstances, such as patients’ or family’s values and preferences Policies will likely be variable Good practice statement Strong Ungraded Same as strong recommendation Same as strong recommendation Same as strong recommendation In our practice statement Not a recommendation NA NA NA NA NA = not applicable.aConditional recommendations were previously categorized as “weak recommendation” in prior guideline iterations. Scope These guidelines apply to all patients from greater than or equal to 37 weeks of gestation at birth to 18 years with probable or confirmed sepsis or suspected or confirmed septic shock. For these guidelines, sepsis is defined as severe infection leading to life-threatening organ dysfunction and septic shock is defined as a subset of sepsis that includes life-threatening cardiovascular the of sepsis may be in clinical we language for sepsis and suspected septic shock all and with with organ dysfunction are included in this For we will use the to to and in these guidelines. TABLE - Sepsis in This Sepsis leading to life-threatening organ inclusive of patients with septic shock Septic shock of sepsis with cardiovascular dysfunction not to a concurrent or sepsis Clinical consistent with but infection not confirmed septic shock Shock of but suspected to be to infection Septic shock with Sepsis with of recommendations apply to children with sepsis or septic shock specific subset with are included in the We that sepsis as a and some children without organ dysfunction may benefit from as with organ Recommendations were developed to be that of and and will determine the of these guidelines. These guidelines not or when with clinical OF THE 2026 SSC GUIDELINES The 2026 guidelines statements and management of infection and and and were strong were conditional were and were statements of insufficient evidence to a with the 2020 guidelines, recommendations are were for new were reviewed but not and were based on of the panel that new evidence was not Only recommendations were based on or moderate of evidence. “in our practice” statements were included the panel’s practice as determined of the panel These statements are not an of a specific but panelists by absence of or clinical key recommendations to the of children with probable sepsis or suspected septic guide for in children with probable sepsis without shock or suspected septic shock. 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