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Management of Sepsis and Septic Shock 2026

- METHODOLOGY

A comprehensive search for guidelines was done to identify the most relevant ones to consider for adaptation. For the literature review, potentially relevant clinical studies were identified via electronic and manual searches of the literature. The updated searches covered a 10-year period from January 1, 2016, to April 30, 2026. The inclusion/exclusion criteria that were followed in the search and retrieval of guidelines are adapted.

➡️We selected guidelines only if they are:

-  Evidence-based guidelines.

-  National and/or international guidelines.

-  Guidelines published from 2016 to April 2026.

-  Peer reviewed publications.

-  Guidelines written in English language.

➡️We Excluded guidelines that are:

-  Written by a single author not on behalf of an organization as guideline to be valid and comprehensive, ideally requires multidisciplinary input.

-  Published without references as the GDG panel needs to know whether a thorough literature review was conducted and whether the current evidence was used in the preparation of the recommendations.

All retrieved Guidelines were screened and appraised using AGREE II instrument (www.agreetrust.org) by at least three members of the GDG. The panel decided on a cut-off point or ranked the guidelines (any guideline scoring above 50% on the rigor dimension was retained).

➡️Guidelines used in the Adaptation Process:

The basic elements of the international guidelines for the management of sepsis and septic shock published by international societies can be successfully implemented in the practice of surgical intensive care worldwide. The Guidelines Development Group (GDG) for the Egyptian Board of Anesthetics, Surgical Intensive Care, and Pain Management has adopted with modification:

1.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic shock 2026. Critical Care Medicine April 2026; 54 (4):715-812 (Reference No. 1)

2.  Singer M, Deutschman CS, Seymour CW, et al: The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315:801–810 (Reference No. 2)

3.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Evans L, Rhodes A, Alhazzani W, et al: Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181–1247 This article was simultaneously published in Critical Care Medicine (DOI: https://doi.org/10.1097/ CCM.0000000000005337) and Intensive Care Medicine (DOI: https://doi.org/10.1007/ s00134-021-06506-y). (Reference No. 24)

4. Rhodes A, Evans LE, Alhazzani W, et al: Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017; 45:486–552 (Reference No. 32)

5. Mekontso Dessap A, AlShamsi F, Belletti A, et al: European Society of Intensive Care Medicine: European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: Part 2-the volume of resuscitation fluids. Intensive Care Med 2025; 51:461–477 (Reference No. 41)

6. Thwaites L, Nasa P, Abbenbroek B, et al: Management of adult sepsis in resource-limited settings: Global expert consensus statements using a Delphi method. Intensive Care Med 2025; 51:21–38 (Reference No. 77)

7.  Ostermann M, Alshamsi F, Artigas Raventos A, et al: European society of intensive care medicine clinical practice guideline on fluid therapy in adult critically ill patients: Part 3-fluid removal at de-escalation phase. Intensive Care Med 2025; 51:1749–1763 (Reference No. 217)

    Strength of Recommendations

The strength of a recommendation communicates the importance of adherence to the recommendation.

Strong Recommendations

The GDG found that the desirable effects of adherence to the recommendation outweigh the undesirable effects. This means that in most situations the recommendation can be adopted.

 

Conditional Recommendations

This means that the GDG found that there is:

▪ Greater uncertainty about the strength of evidence, or

▪ The recommendation may account for a greater variety in patient values and preferences, or

▪ The resource use makes the intervention suitable for some, but not for other locations.

Conditional recommendations are still the best available evidence to date, and it can be adopted if it meets the conditions mentioned with it.

Good Practice Statement (GPS)

Statements based on expert opinion of respected authorities, and the guidelines development group.