: The newest guidelines shift to a more nuanced, patient-centered approach and away from strict targets for all patients.
An overview of Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026
Background
This is the fifth update to the guidelines, which were previously updated in 2021. The recommendations, from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, are based on best available evidence (assessed by the GRADE approach) as well as cost, equity, feasibility, and patient values.
Key Recommendations
- In screening for sepsis, favor tools such as systemic inflammatory response syndrome (SIRS) criteria and modified Early Warning Score (MEWS) over the quick Sequential Organ Failure Assessment (qSOFA), which is less sensitive.
- Administer fluids before vasopressors for persistent hypotension; the groups conditionally recommend an initial fluid bolus of 30 ml/kg. However, patients in unstable shock can receive fluids and vasopressors together. (The groups acknowledge that debate on vasopressor timing continues.)
- Resuscitate to a mean arterial pressure of 65 mm Hg for adults <65 years of age. Some evidence suggests the target may be lower (60–65 mm Hg) for adults 65 years of age or older.
- Order blood cultures before antibiotics. Administer antibiotics within 1 hour for patients in shock or for those with definite or probable sepsis. However, for more stable patients or those with less certainty of the diagnosis, waiting up to 3 hours is reasonable.
- Consider active fluid removal (i.e., diuresis or ultrafiltration) after the initial phase of resuscitation.
Comment
This update reflects a transition to more patient-centered treatment and a movement away from strict “one size fits all” recommendations for patients with sepsis. The guidelines highlight ongoing uncertainty regarding initial resuscitation, methods used to guide resuscitation, and timing of antibiotics, because of conflicting results or a paucity of convincing evidence. They also strike more of a balance between antimicrobial stewardship and early, broad administration of antibiotics. Despite the many new recommendations, we should be able to implement them relatively easily, as they are mostly small tweaks to care as opposed to major changes.