What has changed in the updated 2026 Surviving Sepsis Campaign (SSC) guidelines for children?
In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with pediatric SSC guideline cochairs Scott L. Weiss, MD, MSCE, FCCM, and Pierre Tissieres, MD, DSc, about the latest guideline recommendations for the care of children with sepsis and septic shock. The updated guidelines emphasize the early identification of sepsis, an evolution to a more targeted way of treatment, and a more practical approach to guideline implementation. Other aspects of the previous guidelines, such as lactate measurements, continuous reassessment, and the role of point-of-care monitoring, were reinforced in the 2026 guidelines.
The guidelines, “Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026,” were released in the April issue of Pediatric Critical Care Medicine.
Key updates and new areas of emphasis include:
A more nuanced approach to sepsis screening and early recognition
New guidance on supplemental oxygen, including limiting hyperoxia and using more conservative oxygenation targets in children with septic shock
New patient, intervention, comparison, outcome questions related to immune dysregulation, highlighting an important area for future research
New attention to post-sepsis morbidity
Greater emphasis on long-term follow-up and risk assessment for children who survive sepsis
Scott L. Weiss, MD, MSCE, FCCM, is division chief of critical care and vice-chair of research at Nemours Children’s Hospital (DuPont)-Delaware, Wilmington, Delaware, USA, and professor of pediatrics and pathology and genomic medicine at the Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Pierre Tissieres, MD, DSc, is a professor of pediatrics and head of Pediatric ICU and Neonatal Medicine at Paris South University Hospitals in Paris, France.
This podcast is sponsored by Vantive.
At Vantive, our mission to extend lives and expand possibilities starts with a commitment to continuous learning. We are committed to partnering with the medical community to support vital organ therapy innovation grounded in clinical evidence and focused on improving patient outcomes. The recent publication on endotoxic septic shock centers on an evidence-based approach to address clinical challenges in critical care and beyond as highlighted in our press release.
Resources referenced in this podcast:
Announcer: At Vantive, our mission to extend lives and expand possibilities starts with a commitment to continuous learning. We are committed to partnering with the medical community to support vital organ therapy innovation grounded in clinical evidence and focused on improving patient outcomes. The recent publication on endotoxic septic shock centers on an evidence-based approach to address clinical challenges in critical care and beyond as highlighted in our press release.
Please visit our website, vantive.com to learn more.
Dr. Mack: Hello and welcome to the 2026 Congress edition of the Society of Critical Care Medicine podcast. I'm your host, Dr. Elizabeth Mack. And today I'm speaking with Dr. Scott Weiss, MD, FCCM, and Dr. Pierre Tissieres, MD, PhD, about the 2026 updates to the Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock in Children. The full article is available in Pediatric Critical Care Medicine or pccmjournal.org and Intensive Care Medicine. Listeners can also access the guidelines at survivingsepsis.org. Dr. Weiss is Division Chief of Critical Care and Vice Chair of Research at Nemours Children's Hospital, Delaware and Professor of Pediatrics and Pathology and Genomic Medicine at the Sidney Kimmel Medical College of Thomas Jefferson University. Dr. Tissieres is Professor of Pediatrics, Head of Pediatric ICU and Neonatal Medicine at Paris-Saclay University Hospitals and Director of the Host Pathogen Interactions and Sepsis Group at Integrative Cell Biology Institute at the French National Research Institute, CNRS, and French Sepsis Institute in Paris, France. Welcome!
Dr. Weiss: Thank you. It's a pleasure to be here.
Dr. Tissieres: Thank you. It's a real pleasure to be with you today.
Dr. Mack: Before we start, do you have any disclosures to report?
Dr. Weiss: I have received some honorarium and travel support from Thermo Fisher Scientific.
Dr. Tissieres: I have some consulting fee from Thermo Fisher, Bayon, from Beatrice, and from Sedana as part of my regular job.
Dr. Mack: Wonderful. So as we get started, especially for our trainees and junior folks, I always like to highlight the connections that we have within critical care. And I would love to hear a little bit about how this group first gathered.
What have you worked on before together? Love to hear your thoughts.
Dr. Tissieres: So it's a long story. The ‘26 guidelines is the evolution, the update of the 2020 guidelines. And at that time, with Scott, Tex Kisson, as well as Mark Peters, we got a group of experts from every countries, from Europe, from the US, also elsewhere, with professionals from different disciplines and the pharmacists.
So everybody that is working in the ICU. And we found a way to group all those experts together to build up the first 2020 guidelines. And the ‘26 is just the evolution of maturation, we say, from the previous ones.
Dr. Weiss: Yeah, I'll just add that it was very important that we had a diversity of opinions across disciplines as well as regions, noting that there are practice differences. And we wanted to make sure that the guidelines would be as universally applicable across all settings, healthcare environments, resource limitations, and so on. So we had to have a panel that was representative of all those areas.
Dr. Mack: Wonderful. And it really looks like you all enjoyed working on it, as best I can tell from your presentation today at Congress. So give us the skinny, what are the main changes that critical care professionals should be expecting?
Dr. Weiss: So some key differences are that there were updates to areas about screening for sepsis or early recognition, highlighting that the field has evolved a little bit in terms of what people are doing to recognize sepsis early in their healthcare setting. And now, more recent studies suggesting that are not clearly demonstrating that screening tools are always helpful in all settings. And so we need to better understand how do we utilize those screening tools in the current state of increased emphasis on early recognition of sepsis.
Another area that was new to the guidelines was the use of supplemental oxygen. We have new high quality data that helped to drive a recommendation about limiting hyperoxia and utilizing more conservative oxygenation targets in order to safely provide that therapy to children with septic shock. We also asked new PICO questions regarding immune dysregulation, and unfortunately weren't able to provide many recommendations in those areas, but simply incorporating and highlighting the importance of that, we're hopeful will stimulate new opportunities for research in the future.
And then last, for the first time, we addressed issues of post-sepsis morbidity and opportunities for optimizing long-term follow-up and risk assessment for children who survive sepsis, who have the potential to go on to have neurobehavioral, neurocognitive problems even after they leave the hospital.
Dr. Tissieres: I will add also that there is in comparison to the 2020 guidelines is that some aspects were already present in those guidelines were reinforced, for example, lactate measurements, continuous reassessment, role of point of care assaults and monitoring that were presented in the 2020 guidelines, but now I'm not consider as a stronger objectives.
Dr. Mack: Wonderful. Thank you so much. I know that the critical care community will look forward to diving in.
How do your proposed approach and definitions differ from the original Goldstein criteria and the later modifications that followed? And why do you think those changes were necessary for this iteration?
Dr. Tissieres: It's a very good question. Actually, we started in the 2020 guidelines discussing whether, which are the topics of sepsis because it's made mostly difficult. And now we found out that we have a very practical approach to the definition saying that sepsis is an infection with organ dysfunction and septic shock is the same plus a cardiovascular failure.
What is new in this iteration is that we have the possible sepsis, which is a condition where you consider the patient has sepsis, but you don't have the microbiology demonstration, but you need to start treating the patient. So it's very practical. It's very helpful for the clinicians and for the young fellow to know that even though they don't have a definitive diagnosis, they can consider that this is sepsis and they need to start working on it.
Dr. Weiss: I will add that we were grateful to have the updated 2024 Phoenix conceptualization of sepsis that aligned the pediatric concept of sepsis with the adult Sepsis-3 framework. And so that allowed us to standardize the language, not only within the pediatric guidelines, but across the pediatric and adult guidelines, which I think will be helpful to reduce confusion about the patients for whom these guidelines are most effective.
Dr. Mack: Thank you so much. How does the group think about the balance between early identification, over-diagnosis, over-treatment, particularly in children with high baseline inflammatory states, like many of our chronically critically ill children?
Dr. Tissieres: What Scott just said before is one of the major innovations of the guidelines is the importance of the early identification of the patient. And that showed that we move away from a systematic screening. So at some point, I think it's a major evolution of those guidelines.
Dr. Weiss: Yeah. So I think, you know, a lot of the guidelines, a lot of the recommendation statements have shown evolution from more is more to a more targeted limited approach where we're not falling into a pattern of over-treating unintentionally. And at Congress this morning, Dr. Ranjit provided a really nice overview of how the recommendations and guidelines have shifted over the last two decades to do targeted limited approach and not necessarily trying to normalize all parameters, but rather take a multimodal approach to assessments and a more careful, titrated manner. And a lot of the recommendations reflect that global change over the last two decades.
Dr. Mack: Thank you so much. I'm curious, you know, as we think about sort of the dissemination and implementation of this iteration of the guidelines, what do you think that looks like? Or how do you think that looks different at 2 a.m. in a busy ICU when maybe the medical director is not around?
You know, how might that look different for our teams?
Dr. Weiss: I think we were very sensitive to that important point because that's the situation where the guidelines I think can be most helpful. Those are people who may not live and breathe the guidelines every day, but occasionally come into a situation where they need that information and they need it right away. So in this iteration, we provided a more helpful figure that brings together most of the recommendations into one bite-sized piece that hopefully can provide people the information they need at a glance without having to comb through pages and pages of guidelines and rationale.
Dr. Tissieres: A more practical approach to the implementation of the guidelines, I think.
Dr. Mack: How well do you think this framework performs in our chronically critically ill population, like our patients maybe with oncologic diagnoses or baseline organ dysfunction, maybe those who are tracheostomy ventilator dependent? Do you feel like this is really applicable across populations? And I'm just curious your thoughts on that.
Dr. Tissieries: I think that the contextualization, the clinical contextualization for the application of the guidelines are really important. Part of it is the different types of patients. I mean, oncologic patient, chronic patient, immunosuppressed patient.
At the end, the idea is really to bring up a canvas of guidelines that will have the clinician to apply standard procedures to take care and cure those patients.
Dr. Mack: Any potential unintended consequences in your view of widespread adoption, such as over-treatment, antibiotic overuse, alert fatigue? It sounds like you all are really thoughtful about the practical tactical pieces of this, but just curious your perspective on that.
Dr. Weiss: Yeah, I think it's important to point out that we utilize the GRADE methodology, which provides a framework for a rigorous assessment of the literature and only allows for conditional or strong recommendations if the evidence is there to make those recommendations. So in many cases, we were unable to issue—the evidence was insufficient to issue a recommendation. That does not mean that some patients might still benefit from either giving or withholding that particular intervention.
And so the guideline should be sought to provide a framework for care that's applicable for most patients in most cases, but don't obviate the need for individualization and personalization. And so will work best when implemented in a thoughtful way for an individual patient.
Dr. Mack: All right. So let's dream for a minute. Let's just say we're here at Congress in five or 10 years talking about future guidelines. What is the next generation of pediatric sepsis guidelines, pediatric sepsis definitions look like you think will be incorporating biomarkers, machine learning, continuous monitoring? I won't hold you to it, but would love to hear your thoughts.
Dr. Tissieres: I mean, for sure, better typing the patient might be very helpful in selecting the most appropriate therapy. But I think that one of the mainstream of those ‘26 guidelines is that we were able to identify some potential track of evolution of improvement through research. And what we saw, for example, from the 2020 guidelines is that it brought a lot of energy towards developing RCTs, trying to answer those questions.
So I think that in the future, we will have more deep phenotyping of the patient, better identification of the patient. It should not be at the pace of complexity, but clearly it's also an opportunity to develop more advanced research and opportunities in caring for those children.
Dr. Weiss: Yes, I agree with Dr. Tissieres. And I think guidelines are very important to standardize care, but the aim of guidelines is to improve care for groups of patients. And when we are moving towards better sub-phenotyping, we'll eventually be able to personalize care and know which subgroups of patients should be treated differently than others. And then we can maximize the benefits for all patients as opposed to the average patient.
Dr. Mack: Thank you so much. Anything I've left out or you wanted to touch on that we didn't cover?
Dr. Tissieres: So for me, one of the other benefits of these guidelines is the novelty of bringing together clinicians and experts from all around the world under the SCCM and the ESICM umbrella. And for me, it was a real pleasure to find out new friends and work together and to develop a very important document for the clinicians.
Dr. Weiss: Yeah, I agree. I mean, the global community around this, it's a real rallying point for everybody to come together and bring things like this together. And you know, a lot of the work has stimulated ongoing research that, with the next iteration, will turn into new, stronger recommendations.
There are ongoing studies around fluid management, blood pressure targets, use of corticosteroids, vasopressors, immune modulation, all of which are actively being conducted. And so the next round of the guidelines, I think, will have even more robust evidence base because of, you know, many of these studies are all multi-centered, many are multinational, and that brings together a lot of people working together to improve the health for patients all around the world.
Dr. Mack: Well, thank you so much for your time today, and more importantly, for your work over the last six years, and really combing through the evidence and trying to find, you know, our North Star in terms of how we identify and manage these really important group of patients that we care for. I really appreciate it.
This concludes another episode of the Society of Critical Care Medicine podcast. If you're listening on your favorite podcast app and like what you heard, consider rating and leaving a review. For the Society of Critical Care Medicine podcast, I'm Elizabeth Mack.
Announcer: At Vantive, our mission to extend lives and expand possibilities, starts with the commitment to continuous learning. We are committed to partnering with the medical community to support vital organ therapy innovation grounded in clinical evidence and focused on improving patient outcomes. The recent publication on endotoxic septic shock centers on an evidence-based approach to address clinical challenges in critical care and beyond as highlighted in our press release.
Please visit our website, vantive.com, to learn more.
Elizabeth H. Mack, MD, MS, FCCM, is a professor of pediatrics and chief of pediatric critical care at Medical University of South Carolina Children's Health in Charleston, South Carolina.
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