The Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) recently published a 2026 update to their guideline Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock. This new version updates and replaces many recommendations from the 2021 Surviving Sepsis Campaign guideline.

A total of 129 recommendations are included in the 2026 guideline. Below, we break down the full list into groupings based on overall recommendation strength and changes in status. View the full-text version of the guideline for a complete look at all the recommendations.

Recommendations with the Strongest Strength of Recommendation Which Are Supported by the Highest Levels of Certainty of Evidence (Moderate and High):
  • For hospitals and health systems, we recommend using a performance improvement program for sepsis, including sepsis screening for acutely ill, high-risk patients; standard operating procedures for treatment; and implementation of sepsis quality improvement strategies.
  • For acutely ill patients in hospital, we recommend using NEWS, NEWS2, MEWS, or SIRS over qSOFA as a single tool to screen for sepsis.
  • For adults with septic shock, we recommend an initial MAP target of 65 mm Hg over higher MAP targets.
  • For adults with sepsis or septic shock, we recommend using prolonged infusion of beta-lactams for maintenance (after an initial loading dose) over bolus administration.
Upgraded/Downgraded Recommendations From the 2021 Version:
  • (Upgraded) For adults with sepsis or septic shock, we recommend using prolonged infusion of beta-lactams for maintenance (after initial bolus) over conventional bolus infusion.
    • Previously: For adults with sepsis or septic shock, we suggest using prolonged infusion of beta-lactams for maintenance (after an initial bolus) over conventional bolus infusion.
  • (Upgraded) For adults with sepsis or septic shock, we recommend de-escalation of antimicrobial therapy over no de-escalation when a confirmed microbiological diagnosis and susceptibility profile is available.
    • Previously: For adults with sepsis or septic shock, we suggest de-escalation of antimicrobial therapy over no de-escalation when a confirmed microbiological diagnosis and susceptibility profile is available.
  • (Upgraded) For adults with sepsis or septic shock undergoing initial resuscitation, we suggest using balanced crystalloids over 0.9% saline.
    • Previously: For adults with sepsis or septic shock, we suggest using balanced crystalloids instead of normal saline for resuscitation.
  • (Upgraded) For adults with sepsis or septic shock who have already received fluid resuscitation with 30 ml/kg and have persistent hypoperfusion, we suggest using either a liberal or a restrictive fluid resuscitation strategy based on individual patient and health system factors.
    • Previously: There was insufficient evidence to make a recommendation on the use of restrictive versus liberal fluid strategies in the first 24 hours of resuscitation in patients with sepsis and septic shock who still have signs of hypoperfusion and volume depletion after the initial resuscitation. 
  • (Upgraded) For adults with sepsis or septic shock, we suggest using dynamic measures to guide initial fluid resuscitation over physical examination or static measures alone.
    • Previously: For adults with sepsis or septic shock, we suggest using dynamic measures to guide fluid resuscitation, over physical examination, or static parameters alone.
  • (Downgraded) For adults with septic shock, we suggest using norepinephrine as the first-line agent over vasopressin or angiotensin II.
    • Previously: For adults with septic shock, we recommend using norepinephrine as the first-line agent over other vasopressors.
  • (Downgraded) For adults with septic shock and inadequate MAP levels despite norepinephrine and vasopressin, we suggest adding epinephrine.
    • Previously: For adults with septic shock and inadequate mean arterial pressure levels despite norepinephrine and vasopressin, we suggest adding epinephrine.
  • (Downgraded) For adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate fluid status and arterial blood pressure, we suggest using inotropes over no inotropes.
    • Previously: For adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood pressure, we suggest either adding dobutamine or using epinephrine alone.
  • (Downgraded) For adults with septic shock with persistent hypoperfusion and cardiac dysfunction despite adequate fluid resuscitation and arterial blood pressure, we suggest adding dobutamine to norepinephrine or using epinephrine alone.
    • Previously: For adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood pressure, we suggest either adding dobutamine or using epinephrine alone.
  • (Downgraded) For adults with septic shock, we suggest using intravenous corticosteroids.
    • Previously: For adults with septic shock and an ongoing requirement for vasopressor therapy, we suggest using IV corticosteroids.
  • (Downgraded) For adults with sepsis or septic shock, we suggest against using blood purification therapies, including hemoperfusion, high-dose hemofiltration, or plasma exchange.
    • Previously: For adults with sepsis or septic shock we suggest against using polymyxin B hemoperfusion.

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