Complete clinical reference for the 2026 Surviving Sepsis Campaign international guidelines — 129 evidence-based recommendations covering screening, antimicrobial therapy, hemodynamic management, respiratory support, adjunctive therapies, goals of care, transitions, and long-term outcomes in adult sepsis and septic shock.
The 2026 Surviving Sepsis Campaign (SSC) guidelines represent the most comprehensive update to international sepsis management recommendations since 2021, jointly developed by the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). A 69-person guidelines committee representing 23 countries — with 38% of panelists currently or previously practicing in low- or middle-income countries — produced 129 recommendation statements across six major clinical domains using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology and Evidence-to-Decision (EtD) framework.1
This guideline update introduces 46 new or revised recommendation statements and carries over 83 statements from the 2021 guidelines. Key changes from 2021 include new recommendations on code sepsis protocols, prehospital screening and antibiotics, novel host response diagnostics, MDR pathogen coverage stratification, anaerobic coverage, prolonged beta-lactam infusion (now a strong recommendation based on the BLING III trial), selective decontamination of the digestive tract, peripheral vasopressor initiation, HFNC over conventional oxygen and NIPPV, awake proning, active fluid removal, antipyretic avoidance, beta-blocker avoidance, and comprehensive transitions of care and long-term outcome guidance.
The SSC 2026 guidelines define sepsis as life-threatening acute organ dysfunction due to infection, and septic shock as a subset with circulatory dysfunction conferring higher mortality risk, consistent with the Sepsis-3 consensus definitions. A new standardized terminology framework classifies diagnostic certainty as definite, probable, possible, or unlikely sepsis to guide antimicrobial timing decisions.
Contents:
| Part | Title | Coverage |
|---|---|---|
| Part 1 | Screening & Early Management | Performance improvement programs, code sepsis protocols, prehospital screening, in-hospital screening tools (NEWS2, MEWS, SIRS, qSOFA), biomarkers and rapid host response diagnostics, blood cultures, lactate measurement, initial fluid resuscitation (30 mL/kg crystalloid), vasopressor timing, peripheral vasopressor initiation, MAP targets (65 mmHg; 60–65 mmHg for age ≥ 65), ICU admission timing |
| Part 2 | Infection — Antimicrobial Therapy & Source Control | Antimicrobial timing by diagnostic certainty, prehospital antibiotics, biomarker-guided initiation, source control within 6 hours, empiric MDR pathogen coverage stratification, antifungal therapy, anaerobic coverage, Candida biomarkers, rapid diagnostic tests, prolonged beta-lactam infusion, therapeutic drug monitoring, de-escalation, procalcitonin-guided discontinuation, selective decontamination of the digestive tract |
| Part 3 | Hemodynamic Management | Blood pressure monitoring (invasive vs. noninvasive), crystalloids as first-line fluid, balanced crystalloids over 0.9% saline, albumin supplementation, liberal vs. restrictive fluid strategies, dynamic measures for fluid responsiveness, cardiac output monitoring, serial lactate measurement, capillary refill time, vasopressor hierarchy (norepinephrine → vasopressin → epinephrine), vasopressor dosing, inotropes, methylene blue, midodrine, beta-blockers |
| Part 4 | Respiratory Support | Oxygenation monitoring (SpO2 vs. ABG), oxygen targets, high flow nasal cannula, HFNC vs. NIPPV, awake proning, lung-protective ventilation (6 mL/kg), tidal volumes without ARDS, plateau pressure limits, higher PEEP, incremental PEEP titration, prone ventilation > 12 hours, intermittent NMBA boluses, veno-venous ECMO |
| Part 5 | Adjunctive & Supportive Therapies | IV corticosteroids, antipyretic therapy, IV vitamin C, IV immunoglobulins, blood purification (hemoperfusion, hemofiltration, plasmapheresis), polymyxin B hemoperfusion, vitamin D, XueBiJing, stress ulcer prophylaxis (PPIs), probiotics, active fluid removal, restrictive transfusion, enteral nutrition, insulin therapy, renal replacement therapy, sodium bicarbonate, VTE prophylaxis (LMWH over UFH) |
| Part 6 | Goals of Care, Transitions & Long-Term Outcomes | Goals of care discussions, standardized criteria for GoC, advanced directives, time-limited trials, palliative care integration, ICU transition programs, handoff processes, economic and social support screening, medication reconciliation, hospital discharge planning, patient and family education, PCP education, post-critical illness follow-up services, physical rehabilitation, mental health support, cognitive recovery |
Recommendation Classification System:
| Category | Strength | Language | Certainty of Evidence | Implication |
|---|---|---|---|---|
| Strong recommendation | Strong | “We recommend” | High or moderate | Most individuals should receive the intervention; suitable for performance metrics |
| Conditional recommendation | Weak | “We suggest” | Any | Different choices appropriate for different patients; clinicians should consider shared decision-making |
| Good practice statement | Strong | “Clinicians should…” | Ungraded (clear net benefit, evidence difficult to summarize) | Same as strong recommendation |
| In our practice statement | Not a recommendation | “In our practice, XX% of panelists…” | NA | Describes current practice variation; not guidance |
| No recommendation | — | “Insufficient evidence” | — | Evidence insufficient to support any recommendation |
Sepsis Terminology Used in This Guideline:
| Term | Definition |
|---|---|
| Definite sepsis | Sepsis confirmed based on history, clinical examination, and diagnostic testing; an alternative diagnosis is very unlikely |
| Probable sepsis | High suspicion; sepsis is the most likely diagnosis; an alternative diagnosis is less likely |
| Possible sepsis | Moderate suspicion; an alternative diagnosis is also likely based on available data |
| Unlikely sepsis | Low suspicion; clinical assessment is not consistent with sepsis, or an alternate diagnosis is more likely |
Prescott HC, Antonelli M, Alhazzani W, et al. “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026.” Crit Care Med. 2026;54(4):XX-XX. DOI: 10.1097/CCM.0000000000007075 ↩︎
Surviving Sepsis Campaign 2026 recommendations for goals of care discussions, advanced directives, time-limited trials, palliative care, ICU transition programs, handoff processes, medication reconciliation, discharge planning, patient and family education, post-critical illness follow-up, physical rehabilitation, mental health support, and cognitive recovery in adult sepsis and septic shock.
Surviving Sepsis Campaign 2026 recommendations for IV corticosteroids, antipyretic therapy, IV vitamin C, IV immunoglobulins, blood purification, polymyxin B hemoperfusion, vitamin D, XueBiJing, stress ulcer prophylaxis, probiotics, active fluid removal, restrictive transfusion, enteral nutrition, insulin therapy, renal replacement therapy, sodium bicarbonate, and VTE prophylaxis in adult sepsis and septic shock.
Surviving Sepsis Campaign 2026 recommendations for oxygenation monitoring, oxygen targets, high flow nasal cannula, noninvasive positive pressure ventilation, awake proning, lung-protective ventilation, tidal volumes, plateau pressure limits, PEEP strategy, prone ventilation, neuromuscular blockade, and veno-venous ECMO in adult sepsis and septic shock.
Surviving Sepsis Campaign 2026 recommendations for blood pressure monitoring, fluid type selection, balanced crystalloids, albumin, liberal vs restrictive fluid strategies, dynamic measures for fluid responsiveness, cardiac output monitoring, serial lactate, capillary refill time, vasopressor hierarchy, inotropes, methylene blue, midodrine, and beta-blockers in adult sepsis and septic shock.
Surviving Sepsis Campaign 2026 recommendations for antimicrobial timing by diagnostic certainty, prehospital antibiotics, source control, empiric MDR and antifungal coverage, anaerobic coverage, rapid diagnostics, prolonged beta-lactam infusion, therapeutic drug monitoring, de-escalation, procalcitonin-guided discontinuation, and selective decontamination of the digestive tract.
Surviving Sepsis Campaign 2026 recommendations for performance improvement programs, code sepsis protocols, prehospital and in-hospital screening, biomarkers, blood cultures, lactate measurement, initial fluid resuscitation, vasopressor timing, peripheral vasopressor initiation, MAP targets, and ICU admission.