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Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026
Scott L Weiss1,2, Mark J Peters3,4, Simon J W Oczkowski5,6
1Division of Critical Care, Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE.
Insights
Updated guidelines offer expert recommendations for managing pediatric sepsis or septic shock. These evidence-based strategies aim to improve care for critically ill children, despite low-certainty evidence in many areas.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Clinical guidelines
Background:
- Sepsis and septic shock are life-threatening conditions in children.
- Previous guidelines require regular updates to incorporate new evidence and expert consensus.
- Effective management is crucial for improving outcomes in pediatric sepsis.
Purpose of the Study:
- To update evidence-based management recommendations for clinicians treating pediatric sepsis or septic shock.
- To provide current best practices for the care of infants, school-aged children, and adolescents.
Main Methods:
- Convened a panel of 68 international experts and six methodologists.
- Conducted systematic reviews to identify new or updated evidence for Population, Intervention, Control, and Outcomes (PICO) questions.
- Assessed evidence quality using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and formulated recommendations using an evidence-to-decision framework.
Main Results:
- Generated 61 statements on pediatric sepsis/septic shock management.
- Included five strong recommendations, 24 conditional recommendations, and ten good practice statements.
- Only three recommendations were based on high or moderate certainty of evidence, with many PICO questions lacking sufficient evidence for formal recommendations.
Conclusions:
- Issued updated management guidelines for pediatric sepsis or septic shock.
- Acknowledged that most recommendations are based on low-quality evidence.
- Emphasized the need for continued research to strengthen the evidence base for pediatric sepsis care.
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.
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