Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Overview

These international guidelines from the Surviving Sepsis Campaign cover the recognition and management of septic shock and sepsis-associated organ dysfunction in infants, children and adolescents. A multidisciplinary panel drawn from paediatric critical care, emergency medicine, infectious diseases and nursing developed them. Each recommendation is graded by the strength of the evidence behind it, and the panel says openly that many recommendations rest on limited paediatric data. The document is meant for clinicians working in both well-resourced and resource-limited settings.

Recognition and infection management

The guidelines advise systematic screening of acutely unwell children, using protocols adapted to local resources. Cultures should be obtained when they will not delay treatment. Empiric antimicrobial therapy should start promptly and be reassessed and narrowed once microbiological results arrive. Any source of infection that can be controlled should be identified and addressed early.

Haemodynamic and supportive care

Fluid resuscitation is treated with caution. Balanced crystalloids are preferred, fluid is given with repeated reassessment for signs of overload, and the advice differs depending on whether intensive care is available. When shock persists, vasoactive support is recommended, guided by clinical examination and trends in perfusion markers rather than any single target. The panel also covers respiratory support and adjunctive measures such as corticosteroids, blood products, nutrition and endocrine support. Many of these recommendations are conditional.

Implications for practice

The guidelines encourage hospitals to build structured sepsis pathways and to adapt them to the resources they actually have. They also stress family-centred care. They identify research priorities where evidence is weakest, including fluid strategy, vasoactive choice and adjunctive therapies. For clinicians, the central message is to recognise sepsis early, treat infection promptly and resuscitate carefully while reassessing often.