What's next in sepsis? Controversies and future directions from the 2026 Surviving Sepsis Campaign Guidelines

The Surviving Sepsis Campaign Guidelines (SSC) provide evidence-based recommendations for sepsis care relevant to a global audience. While many of the recommendations in the 2026 SSC build upon those in previous iterations, some recommendations point to new directions in the care of patients with sepsis - one characterized by a more flexible approach to the assessment and treatment of individual patient with careful consideration of the benefit of critical care and post-ICU recovery interventions. In this paper, we identify some of these key changes and how modern sepsis practice is changing- a hybrid approach of empiric early treatment alongside a nuanced, personalized stream of care, informed by patient values and preferences. We emphasize key methodological points which inform potentially controversial recommendations, so clinicians may better understand how to implement these in practice.