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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, USA. scott.weiss@nemours.org.
Insights
Updated guidelines offer evidence-based sepsis management for children. These recommendations address sepsis or septic shock in pediatric patients, emphasizing the need for improved evidence quality in clinical practice.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Clinical guidelines
Background:
- Sepsis and septic shock are life-threatening conditions in children.
- Existing guidelines require regular updates to incorporate new evidence and expert consensus.
- Effective management of pediatric sepsis is crucial for improving patient outcomes.
Purpose of the Study:
- To update evidence-based management recommendations for clinicians treating pediatric sepsis or septic shock.
- To provide comprehensive guidance for the care of infants, school-aged children, and adolescents with sepsis.
Main Methods:
- Convened a panel of 68 international experts and six methodologists.
- Conducted systematic reviews to identify and assess evidence quality using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
- Utilized an evidence-to-decision framework to formulate recommendations (strong, conditional, good practice statements).
Main Results:
- Generated 61 statements for pediatric sepsis/septic shock management.
- Included five strong recommendations, 24 conditional recommendations, and ten good practice statements.
- Most recommendations had low certainty of evidence, with only three based on high or moderate certainty.
Conclusions:
- Issued updated management guidelines for pediatric sepsis and septic shock.
- Acknowledged the generally low quality of evidence supporting many recommendations.
- Emphasized the ongoing need for research to strengthen the evidence base for pediatric sepsis care.
Objective:
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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