The Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) recently released a 2026 update to their 2020 guideline on managing sepsis and septic shock in children. The 2026 update, Management of Sepsis and Septic Shock in Children 2026, features 61 recommendations (the 2020 version had 77 recommendations), with 20 entirely new recommendations in addition to recommendations that remained the same as seen in the 2020 release or were updated based on new evidence.

Below, we feature the recommendations that are new in 2026 along with the sections in which they appear. For a complete look at all the recommendations in the 2026 update, including recommendations that remained the same or were updated, view the full-text version of the 2026 Management of Sepsis and Septic Shock in Children guideline. 

New Recommendations in the 2026 Update:

Recognition and Management of Infection

  • For children with probable sepsis or suspected/confirmed septic shock, there was insufficient evidence to issue a recommendation for or against routine molecular testing for pathogen detection or identification.

Antimicrobial Therapy

  • For children with confirmed bacterial sepsis being treated with beta-lactam antibiotics, there was insufficient evidence to recommend for or against routinely using a continuous and/or extended infusion strategy, compared with intermittent dosing.
  • For children with sepsis or septic shock treated with antimicrobial therapy, we suggest not using procalcitonin routinely to guide de-escalation of therapy when effective antimicrobial stewardship programs are in place.
  • For children with sepsis or septic shock with documented bloodstream infection, we suggest hospitals implement routine infectious diseases or medical microbiology consultation for management advice.
  • For children with sepsis or septic shock without documented bloodstream infection, there was insufficient evidence to provide a recommendation about whether hospitals should implement routine infectious diseases consultation.

Hemodynamic Monitoring

  • Resuscitation for children with sepsis or septic shock should be guided by ongoing clinical assessment of markers of hemodynamic status, including heart rate, blood pressure, capillary refill time, extremity temperature, pulse quality, level of consciousness, and urine output (GPS).
  • For children with sepsis or septic shock, we suggest using cardiac and lung POCUS to guide resuscitation, over not using POCUS to guide resuscitation, if local training and resources allow.

Vasoactive Medications

  • For children with septic shock, there was insufficient evidence to issue a recommendation on initiating vasoactive medications either before or after 40 mL/kg of bolus fluid therapy.
  • For children with septic shock with persistent hypoperfusion despite treatment with other vasoactive medications, there was insufficient evidence to issue a recommendation for co-treatment with angiotensin II.
  • For children with septic shock with persistent hypoperfusion despite treatment with other vasoactive medications, there was insufficient evidence to issue a recommendation for co-treatment with methylene blue.

Ventilation

  • For intubated children with sepsis or septic shock following resuscitation, we suggest titrating supplemental oxygen to target a conservative range (Spo 2 88–92%) over a more liberal target (Spo 2 > 94%; conditional recommendation, moderate certainty of evidence).

Endocrine and Metabolic

  • For children with sepsis or septic shock and metabolic acidemia, there was insufficient evidence to issue a recommendation on the use of sodium bicarbonate.

Fluid Balance, Renal Replacement, and Extracorporeal Support

  • For children with sepsis or septic shock, there was insufficient evidence to issue a recommendation on the use of extracorporeal blood purification.
  • It is reasonable to consider measures to prevent excessive fluid administration, monitor total fluid intake, and consider active fluid removal in case of fluid overload after hemodynamic stability is achieved and while closely monitoring hemodynamic changes to avoid compromising end-organ perfusion (GPS).

Immune Therapies

  • For children with sepsis or septic shock, there was insufficient evidence to issue a recommendation on whether to taper or discontinue immunosuppressive therapies.
  • For children with sepsis or septic shock with evidence of leukopenia or immunoparalysis, there was insufficient evidence to issue a recommendation on the use of an immune stimulant.
  • For children with sepsis or septic shock and hyperferritinemia, there was insufficient evidence to issue a recommendation on the use of immunosuppressive therapies.

Long-Term Follow-Up

  • For children with sepsis or septic shock, we suggest implementing an individualized, early rehabilitation bundle during the acute illness rather than not using a rehabilitation bundle.
  • For children with sepsis or septic shock, there was insufficient evidence to recommend for or against targeted post-hospital follow-up.
  • For children who survive sepsis or septic shock, it is reasonable to: 1) assess risk factors for post-sepsis morbidity, 2) educate the patient, family, and clinicians on the symptoms of post-sepsis morbidity, and 3) evaluate for new, long-term sequelae after hospital discharge (GPS).

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