Historical collection · First published Mar 23, 2026; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesSurviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026
Summary
The pediatric update provides 61 statements, but only three recommendations have high- or moderate-certainty evidence. In settings with intensive care availability, it conditionally suggests up to 40–60 mL/kg during the first hour, using repeated small boluses and reassessment.
Why it matters
Reassess perfusion and overload after every bolus and stop when shock resolves or overload develops. Do not apply the ICU-available fluid strategy to settings without intensive care support.
Study at a glance
- Design
- Guideline
- Population
- Infants, children and adolescents with sepsis or septic shock.
- Sample size
- Not applicable
- Intervention
- Updated antimicrobial, fluid, hemodynamic and organ-support recommendations.
- Comparator
- 2020 pediatric SSC guideline.
- Primary endpoint
- GRADE-based recommendations rather than a single trial endpoint.
Main findings
- For suspected septic shock, antimicrobials ideally within one hour: strong recommendation, very-low-certainty evidence.
- With ICU availability, 10–20 mL/kg boluses up to 40–60 mL/kg in the first hour: conditional, low certainty.
- Balanced crystalloid preference is conditional with very-low-certainty evidence; saline remains an alternative.
Limitations
Most recommendations rely on low-certainty evidence or consensus. The guideline preceded PRoMPT BOLUS, which did not demonstrate better major kidney outcomes with balanced fluids.
Recommendation strength
Five strong and 24 conditional recommendations, ten good-practice statements; evidence was insufficient for recommendations on 22 PICO questions.
Read the primary source
Full text: Official society summary available.
Original sourceDOI: 10.1007/s00134-026-08360-2
Material reviewed: official society summary.
Source retrieved Oct 27, 2026. SCCM current recommendations and Springer abstract reviewed. Springer confirms March 23 publication, before the May issue. Complete guideline not reviewed; Pediatric Critical Care Medicine co-publication DOI 10.1097/PCC.0000000000003927 is the same guidance.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.