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Recommendation
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2026 Surviving Sepsis Campaign
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2020 Surviving Sepsis Campaign
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Change from 2020 to 2026
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Patient Assessment
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Systematic screening
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For children who are acutely unwell, there was insufficient evidence to recommend implementing systematic sepsis screening, in addition to established clinical protocols, for the timely recognition of sepsis and septic shock.
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In children who present as acutely unwell, we suggest implementing systematic screening for timely recognition of septic shock and other sepsis-associated organ dysfunction (weak recommendation, very low quality of evidence).
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Updated
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Blood Lactate
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For children with probable sepsis or suspected septic shock, we recommend measuring blood lactate as part of initial evaluation and management (strong recommendation, very low certainty evidence).
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Unable to issue a recommendation about using blood lactate values to stratify children with suspected septic shock or other sepsis-associated organ dysfunction into low- versus high-risk of having septic shock or sepsis.
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Updated
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Hospital protocol / performance improvement
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For children with sepsis or septic shock, we recommend that hospitals implement a performance improvement program, including standard operating procedures for treatment (strong recommendation, low certainty of evidence).
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We recommend implementing a protocol/guideline for management of children with septic shock or other sepsis-associated organ dysfunction (BPS).
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Updated
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Routine molecular pathogen testing
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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.
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Not listed in the 2020 summary recommendations.
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New
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Hemodynamic Management
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Ongoing clinical assessment of hemodynamic status
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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).
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No parallel standalone recommendation in 2020; these markers appeared in remarks tied to fluid reassessment.
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New
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Advanced hemodynamic monitoring
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For children with sepsis and septic shock, there was insufficient evidence to issue a recommendation on use of advanced hemodynamic monitoring along with bedside clinical signs to guide resuscitation.
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We suggest using advanced hemodynamic variables, when available, in addition to bedside clinical variables to guide resuscitation of children with septic shock or other sepsis-associated organ dysfunction (weak recommendation, low quality of evidence).
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Updated
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ScvO2 target
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For children with septic shock, we suggest targeting ScvO2 ≥ 70% when central venous access is available, over not targeting ScvO2 (conditional recommendation, very low certainty evidence).
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In 2020, ScvO2 was included under advanced monitoring, but not as a standalone recommendation
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Updated
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Antimicrobial Management
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Antibiotics for suspected septic shock
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For children with suspected septic shock, we recommend starting antimicrobial therapy as soon as possible, ideally within 1 hour of recognition of sepsis (strong recommendation, very low certainty of evidence).
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In children with septic shock, we recommend starting antimicrobial therapy as soon as possible, within 1 hour of recognition (strong recommendation, very low quality of evidence).
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Updated
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Antibiotics for sepsis without shock
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For children with probable sepsis without shock, we suggest a time-limited course of rapid investigation and, if concern for sepsis is substantiated, starting antimicrobial therapy as soon as possible after appropriate evaluation, ideally within 3 hours of recognition (conditional recommendation, very low certainty of evidence).
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In children with sepsis-associated organ dysfunction but without shock, we suggest starting antimicrobial therapy as soon as possible after appropriate evaluation, within 3 hours of recognition (weak recommendation, very low quality of evidence).
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Updated
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Fluid Therapy
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Initial bolus fluids in systems with intensive care availability
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For children with septic shock being treated in healthcare systems with intensive care availability, we suggest administering up to 40–60 mL/kg in bolus fluid (10–20 mL/kg per bolus) over the first hour of initial resuscitation, over no fluid bolus (conditional recommendation, low certainty evidence).
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In healthcare systems with availability of intensive care, we suggest administering up to 40–60 mL/kg in bolus fluid (10–20 mL/kg per bolus) over the first hour, titrated to clinical markers of cardiac output and discontinued if signs of fluid overload develop (weak recommendation, low quality of evidence).
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Updated Wording
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Vasoactive Medications
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Peripheral vasoactive access
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For children with septic shock requiring vasoactive medications, we suggest initiating vasoactive medications through peripheral venous access over delaying therapy until central venous access is obtained (conditional recommendation, very low certainty of evidence).
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Unable to issue a recommendation about initiating vasoactive agents through peripheral access in children with septic shock; remarks stated peripheral epinephrine or norepinephrine may be used if central access is not readily accessible.
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Updated
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Ventilation / Oxygenation
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Oxygen targets
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For intubated children with sepsis or
septic shock following resuscitation, we suggest titrating supplemental oxygen to target a conservative range (Spo2 88–92%) over a more liberal target (Spo2 > 94%; conditional recommendation,
moderate certainty of evidence).
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No specific oxygen target recommendation
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New
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Long-term Outcomes / Follow-up
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Early rehabilitation
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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 (conditional recommendation, very low certainty evidence).
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Not addressed
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New
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Targeted post-hospital follow-up
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For children with sepsis or septic shock, there was insufficient evidence to recommend for or against targeted post-hospital follow-up.
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Not addressed
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New
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Post-sepsis morbidity assessment after discharge
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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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Not addressed
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New
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