The Surviving Sepsis Campaign, a collaborative effort between the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine, released updated adult and pediatric guidelines at the 2026 Critical Care Congress, in Chicago.
Each set of guidelines (Crit Care Med 2026 Mar 23. doi:10.1097/CCM.0000000000007075; Ped Crit Care Med 2026 Mar 23. doi:10.1097/PCC.0000000000003927) includes dozens of new statements and recommendations based on new studies since the last iterations—in 2021 for adults and 2020 for children. These are the second-ever guidelines for pediatric sepsis care.
The work spans sepsis screening and care during transport to transitional care and recovery. Hallie Prescott, MD, MSc, the lead author of the adult guidelines, emphasized that timely treatment saves lives. “Sepsis remains a time-sensitive medical emergency. Time to treatment of infection and time to hemodynamic resuscitation just remain absolutely key core components, and those are really unchanged,” said Dr. Prescott, the Toews Family Legacy Professor of Pulmonary and Critical Care Medicine at University of Michigan Medical School, in Ann Arbor. “But we want to be nuanced and minimize overly broad antibiotics or too much resuscitation, but again, timely recognition, timely diagnosis, timely treatment just remain important as ever.”
46 New Adult, 20 New Pediatric Statements
In the nearly 200 combined statements, one-fourth of the recommendations are entirely new. This change is partly due to an increase in sepsis research, particularly in pediatric patients. “It is very positive that pediatric intensive care is generating high-quality evidence in a way that it hasn’t previously, although there’s still a significant need for more research,” Mark J. Peters, MBChB, PhD, co-vice chair of the children’s guidelines, said in an SCCM press release. “And we now have a definition of sepsis based not just on expert opinion, but data, which will help clinicians make life-saving decisions quickly.” Dr. Peters is a professor of paediatric intensive care at UCL Great Ormond Street Institute of Child Health, in London.
For the pediatric guidelines, the new iteration broadens the number of topics addressed. For instance, the group has given a conditional recommendation for the use of cardiac and lung point-of-care ultrasound to guide resuscitation when it is available. Other new statements include adjunctive hemodynamic medications, immune modulation, risk assessment for post-sepsis morbidity, and long-term follow-up.
In the adult guidelines, new additions include a conditional recommendation against using anti-anaerobic agents in patients who are at low risk for infection. The effort is one that is “really trying to balance timely treatment for sepsis, but also antimicrobial stewardship and limiting unnecessary antibiotic exposure and complications,” Dr. Prescott said.
Another new addition is a very targeted recommendation, she said. For patients who are hypotensive, have suspected sepsis, and have an estimated hour or longer travel time to the hospital, the guidelines recommend empiric antimicrobial therapy en route to the hospital. “We’re always trying to balance antimicrobial stewardship with timely treatment for sepsis,” Dr. Prescott said. “And so, this is meant to be a targeted recommendation for really those sickest patients who have a prolonged transport time.”
A Winning Combo
The update marks the first simultaneous release of adult and pediatric recommendations, which will be a benefit to many emergency and critical care providers, according to pediatric co-author Halden Scott, MD, MSCS, a professor of pediatrics-emergency medicine at the University of Colorado Denver Anschutz Medical Campus, in Aurora. “Because while in some settings practitioners are only taking care of adults or are only taking care of children, there are many settings, especially emergency departments, where clinicians are caring for both adults and children,” Dr. Scott said. “So having the two expert groups talk to each other and coordinate will present a set of guidelines that allows practitioners to understand where the similarities are and where the differences are in terms of caring for adults and children.
“I think this is a really important step forward.”
Dr. Prescott reported a scientific consultantship with Aurobac Therapeutics. Dr. Scott reported no relevant financial disclosures.