Complete clinical reference for the 2026 Surviving Sepsis Campaign pediatric guidelines — 61 evidence-based recommendations covering recognition, antimicrobial therapy, fluid therapy, hemodynamic management, vasoactive medications, ventilation, corticosteroids, metabolic management, blood products, renal replacement therapy, ECMO, immune therapies, long-term follow-up, and prophylaxis in pediatric sepsis and septic shock.
The 2026 Surviving Sepsis Campaign (SSC) guidelines for children represent the updated international consensus recommendations for managing sepsis and septic shock in pediatric patients, jointly developed by a panel of 68 international experts representing 13 international organizations and six methodologists. Published simultaneously in Pediatric Critical Care Medicine and Intensive Care Medicine, these guidelines provide 61 recommendation statements using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology and Evidence-to-Decision (EtD) framework.1
These guidelines apply to all patients with sepsis or septic shock from greater than or equal to 37-week gestation at birth to 18 years old, managed in hospital, emergency, or acute care settings. Sepsis is defined as infection leading to life-threatening organ dysfunction, and septic shock as a subset that includes life-threatening cardiovascular dysfunction not attributable to a concurrent primary cardiac or other cause.
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 that no new evidence was available. Only three recommendations were based on high or moderate certainty of evidence, underscoring that most aspects of pediatric sepsis care continue to rely on relatively low quality evidence.
Key updates since 2020 include: the 2024 Phoenix Sepsis Definitions providing updated criteria, new recommendations on molecular testing, prehospital considerations for antimicrobial timing, infectious diseases consultation, clinical assessment-based hemodynamic monitoring, POCUS-guided resuscitation, peripheral vasoactive medication initiation, SpO2 targets, procalcitonin for de-escalation, rehabilitation bundles, and post-sepsis follow-up guidance.
Contents:
| Part | Title | Coverage |
|---|---|---|
| Part 1 | Recognition, Screening & Antimicrobial Therapy | Sepsis screening, performance improvement programs, blood lactate, blood cultures, molecular testing, antimicrobial timing (shock within 1 hour, non-shock within 3 hours), broad-spectrum empiric therapy, multidrug-resistant pathogen coverage, beta-lactam infusion strategies, de-escalation, procalcitonin-guided therapy, infectious diseases consultation, pathogen-directed narrowing |
| Part 2 | Source Control, Fluid Therapy & Hemodynamic Management | Emergent source control, intravascular access device removal, fluid bolus volumes (10–20 mL/kg), balanced crystalloids vs. 0.9% saline, fluid therapy in settings without intensive care, maintenance fluid avoidance, hemodynamic monitoring (clinical assessment, ScvO2, advanced monitoring, POCUS) |
| Part 3 | Vasoactive Medications & Ventilation | Vasoactive medication timing, epinephrine vs. norepinephrine, peripheral venous access for vasoactives, high-dose catecholamines and vasopressin, inodilators, angiotensin II, methylene blue, intubation decisions, etomidate avoidance, conservative SpO2 targets (88–92% over > 94%) |
| Part 4 | Corticosteroids, Metabolic & Adjunctive Therapies | Hydrocortisone use and non-use, fever management, sodium bicarbonate, calcium, levothyroxine, vitamin C, thiamine (B1), vitamin D, blood products (deferred), fluid balance management, RRT and high-volume hemofiltration, TAMOF and plasma exchange, VV-ECMO, VA-ECMO, immunosuppressive therapy decisions, IVIG |
| Part 5 | Long-Term Follow-Up & Prophylaxis | Immune stimulants for immunoparalysis, early rehabilitation bundles, targeted post-hospital follow-up, post-sepsis screening (risk factors, education, long-term sequelae evaluation), stress ulcer prophylaxis, deep vein thrombosis prophylaxis |
Sepsis Terminology Used in These Guidelines:
| Term | Definition |
|---|---|
| Sepsis | Infection leading to life-threatening organ dysfunction, inclusive of patients with septic shock |
| Septic shock | Subset of sepsis with inadequate perfusion and/or cardiovascular dysfunction not attributable to a concurrent primary cardiac or other cause |
| Probable sepsis | Clinical presentation consistent with sepsis, but infection not yet confirmed |
| Suspected septic shock | Shock of unconfirmed etiology, but suspected to be secondary to infection |
| Septic shock with persistent hypoperfusion | Sepsis with ongoing signs of hypoperfusion despite initial treatment |
Recommendation Classification:
| Category | Strength | Language | Certainty |
|---|---|---|---|
| Strong recommendation | Strong | “We recommend” | High or moderate |
| Conditional recommendation | Weak | “We suggest” | Any |
| Good practice statement (GPS) | Strong | “Clinicians should…” | Ungraded |
| In our practice statement | Not a recommendation | “In our practice, XX%…” | NA |
Weiss SL, Peters MJ, Oczkowski SJ, et al. “Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026.” Intensive Care Med. 2026. DOI: 10.1007/s00134-026-08360-2 ↩︎
Surviving Sepsis Campaign 2026 pediatric recommendations for immune stimulants in immunoparalysis, immunosuppressive therapy for hyperferritinemia, early rehabilitation bundles, targeted posthospital follow-up, post-sepsis morbidity screening, stress ulcer prophylaxis, VTE prophylaxis, nutrition, and blood products in children with sepsis.
Surviving Sepsis Campaign 2026 pediatric recommendations for hydrocortisone, fever management, sodium bicarbonate, calcium, levothyroxine, vitamin C, thiamine, vitamin D, fluid balance, high-volume hemofiltration, plasma exchange for TAMOF, extracorporeal blood purification, ECMO, immunosuppressive therapy management, and IVIG in pediatric sepsis.
Surviving Sepsis Campaign 2026 pediatric recommendations for vasoactive medication timing, epinephrine vs norepinephrine, peripheral vasoactive initiation, vasopressin, inodilators, angiotensin II, methylene blue, intubation in septic shock, etomidate avoidance, and conservative SpO2 targets in children.
Surviving Sepsis Campaign 2026 pediatric recommendations for emergent source control, intravascular device removal, fluid bolus therapy in septic shock, fluid therapy in non-ICU settings, balanced crystalloids vs saline, hemodynamic assessment, ScvO2 targeting, advanced monitoring, and point-of-care ultrasound in pediatric sepsis.
Surviving Sepsis Campaign 2026 pediatric recommendations for sepsis screening, performance improvement programs, blood lactate, blood cultures, molecular testing, antimicrobial timing, empiric broad-spectrum therapy, beta-lactam infusion strategies, de-escalation, procalcitonin-guided therapy, and infectious diseases consultation in children.