guidelines

Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock in Children 2026

Complete clinical reference for the 2026 Surviving Sepsis Campaign pediatric guidelines — 61 evidence-based recommendations covering recognition, antimicrobial therapy, fluid therapy, hemodynamic management, vasoactive medications, ventilation, corticosteroids, metabolic management, blood products, renal replacement therapy, ECMO, immune therapies, long-term follow-up, and prophylaxis in pediatric sepsis and septic shock.

SSC 2026 — Part 6: Goals of Care, Transitions & Long-Term Outcomes

Surviving Sepsis Campaign 2026 recommendations for goals of care discussions, advanced directives, time-limited trials, palliative care, ICU transition programs, handoff processes, medication reconciliation, discharge planning, patient and family education, post-critical illness follow-up, physical rehabilitation, mental health support, and cognitive recovery in adult sepsis and septic shock.

SSC Children 2026 — Part 5: Long-Term Follow-Up & Prophylaxis

Surviving Sepsis Campaign 2026 pediatric recommendations for immune stimulants in immunoparalysis, immunosuppressive therapy for hyperferritinemia, early rehabilitation bundles, targeted posthospital follow-up, post-sepsis morbidity screening, stress ulcer prophylaxis, VTE prophylaxis, nutrition, and blood products in children with sepsis.

SSC 2026 — Part 5: Adjunctive & Supportive Therapies

Surviving Sepsis Campaign 2026 recommendations for IV corticosteroids, antipyretic therapy, IV vitamin C, IV immunoglobulins, blood purification, polymyxin B hemoperfusion, vitamin D, XueBiJing, stress ulcer prophylaxis, probiotics, active fluid removal, restrictive transfusion, enteral nutrition, insulin therapy, renal replacement therapy, sodium bicarbonate, and VTE prophylaxis in adult sepsis and septic shock.

SSC Children 2026 — Part 4: Corticosteroids, Metabolic & Adjunctive Therapies

Surviving Sepsis Campaign 2026 pediatric recommendations for hydrocortisone, fever management, sodium bicarbonate, calcium, levothyroxine, vitamin C, thiamine, vitamin D, fluid balance, high-volume hemofiltration, plasma exchange for TAMOF, extracorporeal blood purification, ECMO, immunosuppressive therapy management, and IVIG in pediatric sepsis.

SSC 2026 — Part 4: Respiratory Support

Surviving Sepsis Campaign 2026 recommendations for oxygenation monitoring, oxygen targets, high flow nasal cannula, noninvasive positive pressure ventilation, awake proning, lung-protective ventilation, tidal volumes, plateau pressure limits, PEEP strategy, prone ventilation, neuromuscular blockade, and veno-venous ECMO in adult sepsis and septic shock.

SSC Children 2026 — Part 3: Vasoactive Medications & Ventilation

Surviving Sepsis Campaign 2026 pediatric recommendations for vasoactive medication timing, epinephrine vs norepinephrine, peripheral vasoactive initiation, vasopressin, inodilators, angiotensin II, methylene blue, intubation in septic shock, etomidate avoidance, and conservative SpO2 targets in children.

SSC 2026 — Part 3: Hemodynamic Management

Surviving Sepsis Campaign 2026 recommendations for blood pressure monitoring, fluid type selection, balanced crystalloids, albumin, liberal vs restrictive fluid strategies, dynamic measures for fluid responsiveness, cardiac output monitoring, serial lactate, capillary refill time, vasopressor hierarchy, inotropes, methylene blue, midodrine, and beta-blockers in adult sepsis and septic shock.

SSC Children 2026 — Part 2: Source Control, Fluid Therapy & Hemodynamic Management

Surviving Sepsis Campaign 2026 pediatric recommendations for emergent source control, intravascular device removal, fluid bolus therapy in septic shock, fluid therapy in non-ICU settings, balanced crystalloids vs saline, hemodynamic assessment, ScvO2 targeting, advanced monitoring, and point-of-care ultrasound in pediatric sepsis.

SSC 2026 — Part 2: Infection — Antimicrobial Therapy & Source Control

Surviving Sepsis Campaign 2026 recommendations for antimicrobial timing by diagnostic certainty, prehospital antibiotics, source control, empiric MDR and antifungal coverage, anaerobic coverage, rapid diagnostics, prolonged beta-lactam infusion, therapeutic drug monitoring, de-escalation, procalcitonin-guided discontinuation, and selective decontamination of the digestive tract.

SSC Children 2026 — Part 1: Recognition, Screening & Antimicrobial Therapy

Surviving Sepsis Campaign 2026 pediatric recommendations for sepsis screening, performance improvement programs, blood lactate, blood cultures, molecular testing, antimicrobial timing, empiric broad-spectrum therapy, beta-lactam infusion strategies, de-escalation, procalcitonin-guided therapy, and infectious diseases consultation in children.

SSC 2026 — Part 1: Screening & Early Management

Surviving Sepsis Campaign 2026 recommendations for performance improvement programs, code sepsis protocols, prehospital and in-hospital screening, biomarkers, blood cultures, lactate measurement, initial fluid resuscitation, vasopressor timing, peripheral vasopressor initiation, MAP targets, and ICU admission.

Infection Prevention Guidelines

Evidence-based guidelines for infection prevention practice — methodology, implementation, and quality standards.

Infection Prevention

Evidence-based clinical guidelines for infection prevention practice — guideline development methodology, CLABSI prevention, and infection control standards.

ICU Clinical Guidelines

Comprehensive, evidence-based clinical guidelines for intensive care practice — synthesized from multiple professional society recommendations covering sepsis, ventilation, sedation, infection prevention, nutrition, hemostasis, renal support, post-arrest care, and transfusion medicine.

Emergency Medicine

Comprehensive, evidence-based clinical guidelines for emergency medicine practice — cardiac emergencies, stroke, trauma, toxicology, airway management, pediatrics, and procedural care.

Emergency Department Clinical Guidelines

Comprehensive, evidence-based clinical guidelines for emergency medicine practice — synthesized from multiple professional society recommendations covering cardiac emergencies, stroke, trauma, toxicology, airway management, pediatrics, and procedural care.

Critical Care

Comprehensive, evidence-based clinical guidelines for intensive care practice — sepsis, ventilation, sedation, infection prevention, nutrition, hemostasis, renal support, and post-arrest care.

Acute Stroke Management: A Comprehensive Emergency Guideline

Evidence-based guideline for recognition, evaluation, thrombolysis, thrombectomy, and management of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in the emergency department.

Trauma Primary and Secondary Survey — Part 5: Special Trauma Populations

Pediatric trauma (vital signs by age, Broselow, non-accidental trauma), geriatric trauma (anticoagulant reversal, occult shock), pregnant trauma (physiologic changes, perimortem C-section), burns (Parkland formula, rule of nines, escharotomy), and penetrating vs blunt selective non-operative management.

Pediatric Emergencies — Part 5: Common Surgical Emergencies, Trauma & Neonatal Emergencies

Intussusception, pyloric stenosis, testicular torsion, PECARN head CT and abdominal trauma decision rules, solid organ injury non-operative management, non-accidental trauma screening, neonatal emergencies including hypoglycemia, congenital heart disease with PGE1, hyperbilirubinemia, and a comprehensive pediatric medication dosing reference table.

Part 5: Specific Etiologies, Special Populations, and Quality Metrics

COVID-19 ARDS phenotypes and management, transfusion-related acute lung injury, aspiration-related ARDS, immunocompromised patients, obesity and ARDS, pediatric considerations, long-term outcomes, and ICU quality benchmarks for ventilator management.

Part 5: Special Populations & Quality Metrics

PADIS management in special populations including post-operative, neurological injury, substance withdrawal (alcohol/CIWA, opioid/COWS), ECMO and CRRT dosing adjustments, plus quality metrics, bundle compliance measurement, and implementation strategies.

Acute Kidney Injury — Part 5: Special Populations & Long-Term Outcomes

Sepsis-associated AKI, cardiac surgery-associated AKI, contrast-associated AKI, hepatorenal syndrome, rhabdomyolysis, tumor lysis syndrome, AKI in pregnancy, long-term outcomes, CKD progression, nephrology referral criteria, and quality metrics.

Ventilator-Associated Pneumonia — Part 4: Specific Pathogens, Surveillance & Quality Metrics

Pathogen-directed therapy for MRSA, Pseudomonas aeruginosa, Acinetobacter baumannii, ESBL-producing Enterobacterales, and Stenotrophomonas maltophilia with dosing tables, VAE versus traditional VAP surveillance reporting, NHSN definitions and algorithms, quality metrics including VAE rates and bundle compliance, and antibiotic stewardship considerations.

Trauma Primary and Secondary Survey — Part 4: Focused Injury-Specific Assessment

Head injury assessment, cervical spine clearance (Canadian C-Spine Rule, NEXUS), chest injury evaluation, abdominal assessment with AAST organ injury grading (liver, spleen, kidney), pelvic fracture management, extremity vascular injury and compartment syndrome, and spinal injury with TLICS scoring.

Toxicology and Overdose Management — Part 4: Toxic Alcohols, Metals, Organophosphates, Environmental & Chemical Poisonings

Complete management of methanol and ethylene glycol poisoning (fomepizole, hemodialysis), carbon monoxide, cyanide, organophosphates and nerve agents, iron poisoning, caustic ingestions, local anesthetic systemic toxicity (LAST), sympathomimetic toxicity, and enhanced elimination techniques including urinary alkalinization and EXTRIP hemodialysis indications.

Sepsis and Septic Shock — Part 4: Corticosteroids & Organ Support

Corticosteroid indications and evidence in septic shock, mechanical ventilation in sepsis-induced ARDS, renal replacement therapy, blood product management, glucose management, DVT and stress ulcer prophylaxis, and nutrition.

Pediatric Emergencies — Part 4: Neurologic, Metabolic & Fluid Emergencies

Febrile seizure evaluation, status epilepticus protocol with stepwise treatment, clinical dehydration assessment, WHO dehydration classification, ORT protocol, IV fluid calculation with Holliday-Segar rule, hyponatremia correction, and pediatric diabetic ketoacidosis management including 2-bag system and cerebral edema monitoring.

Part 4: Special Populations, Surveillance & Implementation Science

CLABSI prevention in neonates, immunocompromised patients, hemodialysis catheters, and long-term catheters; NHSN surveillance methodology; SIR calculation; CUSP framework; daily goals checklist; nurse empowerment; zero CLABSI sustainability.

Part 4: Non-Invasive Support and Ventilator Liberation

High-flow nasal cannula and FLORALI trial evidence, NIV/BiPAP in ARDS, daily spontaneous breathing trial protocols, SAT-SBT coordination, RSBI, extubation criteria, cuff leak test, post-extubation support, and tracheostomy timing.

Part 4: Early Mobility and Exercise & Sleep Promotion

Safety screening criteria for ICU mobilization, progressive mobility levels, ICU-acquired weakness diagnosis and prevention, barriers to early mobility, sleep disruption assessment and causes, non-pharmacologic and pharmacologic sleep interventions, and circadian rhythm management.

Nutrition in Critical Illness — Part 4: Immunonutrition & Special Populations

Comprehensive guide to immunonutrition (arginine, glutamine, omega-3 fatty acids, antioxidants), and nutrition management in special ICU populations including sepsis, burns, trauma, TBI, acute pancreatitis, ECMO, obesity, chronic critical illness, open abdomen, and CRRT.

Acute Stroke Management — Part 4: Intracerebral Hemorrhage

ICH pathophysiology, ICH Score, hematoma expansion, blood pressure management (INTERACT2, ATACH-2), anticoagulant reversal protocols, surgical intervention criteria (STICH, MISTIE III, ENRICH), and ICP management.

Ventilator-Associated Pneumonia — Part 3: Diagnosis & Antimicrobial Treatment

Clinical diagnostic criteria, CPIS scoring table, microbiologic sampling strategies (ETA, BAL, mini-BAL) with quantitative thresholds, biomarker guidance, empiric antibiotic selection stratified by MDR risk with complete dosing tables and renal adjustments, de-escalation principles, short-course duration evidence, inhaled antibiotics, and treatment failure evaluation.

Traumatic Brain Injury — Part 3: ICP Management & Surgical Indications

ICP monitoring indications, ICP and CPP targets, complete tiered ICP management protocol with dosing, hyperosmolar therapy, EVD drainage, decompressive craniectomy (DECRA, RESCUEicp), barbiturate coma, and surgical indications for epidural hematoma, subdural hematoma, depressed skull fracture, and posterior fossa lesions.

Transfusion in Critical Care — Part 3: Massive Transfusion & Hemorrhage Management

Massive transfusion protocol activation, fixed-ratio transfusion (1:1:1 per PROPPR), TEG/ROTEM viscoelastic testing and interpretation, damage control resuscitation, TXA (CRASH-2), calcium replacement, permissive hypotension, and hemorrhage management in trauma, obstetric, and GI bleeding.

Pediatric Emergencies — Part 3: Pediatric Sepsis & Febrile Infant Evaluation

Pediatric sepsis recognition with age-specific SIRS criteria, sepsis resuscitation protocol, vasopressor selection, antibiotic guidance, febrile infant risk stratification by age, Rochester-Philadelphia-Boston criteria comparison, PECARN febrile infant rule, and neonatal CSF interpretation.

Part 3: Supplemental Prevention Strategies, Diagnosis & Management of CRBSI

Antimicrobial-impregnated catheters, antimicrobial lock therapy, CHG-impregnated dressings, antibiotic ointments, diagnosis of CRBSI (paired blood cultures, differential time to positivity, catheter tip culture), empiric therapy, catheter removal vs salvage, duration of therapy by organism, and suppurative thrombophlebitis.

Part 3: Delirium Assessment, Prevention, and Management

Complete delirium assessment tools (CAM-ICU flowsheet, ICDSC scoring), delirium subtypes, modifiable and non-modifiable risk factors, evidence-based non-pharmacologic prevention bundles, and pharmacologic management including haloperidol, quetiapine, and dexmedetomidine dosing.

Part 3: Adjunctive and Rescue Therapies

Recruitment maneuvers and evidence from the ART trial, conservative fluid management from the FACTT trial, inhaled pulmonary vasodilators, ECMO indications and referral criteria from the EOLIA trial, high-frequency oscillatory ventilation, and corticosteroids in ARDS.

Nutrition in Critical Illness — Part 3: Parenteral Nutrition & Micronutrients

Comprehensive guide to parenteral nutrition in the ICU: indications, timing controversies, composition, lipid emulsions, monitoring, complications, transition to EN, and micronutrient supplementation including thiamine, vitamin C, vitamin D, selenium, zinc, and refeeding syndrome prevention.

Ventilator-Associated Pneumonia — Part 2: Prevention Bundles & Supplemental Strategies

Comprehensive evidence review of VAP prevention bundle components including head-of-bed elevation, sedation management, oral care and chlorhexidine controversy, subglottic secretion drainage, ETT cuff pressure, suctioning, circuit management, early mobility, stress ulcer prophylaxis, and supplemental strategies including SDD/SOD, silver-coated ETTs, and probiotics.

Pediatric Emergencies — Part 2: Pediatric Respiratory Emergencies

Croup scoring and management, bronchiolitis evaluation and supportive care, acute asthma severity classification and stepwise treatment, anaphylaxis recognition and epinephrine dosing, and foreign body aspiration management.

Part 2: Prone Positioning and Neuromuscular Blockade

Indications, protocols, and evidence for prone positioning in ARDS based on the PROSEVA trial, procedural checklists and contraindications, neuromuscular blockade evidence from ACURASYS and ROSE trials, train-of-four monitoring, and current recommendations.

Part 2: Insertion Bundle & Maintenance Bundle

Evidence-based insertion bundle components (hand hygiene, maximal sterile barriers, chlorhexidine antisepsis, site selection, daily necessity review) and maintenance bundle components (hub disinfection, CHG bathing, dressing management, needleless connectors, administration set changes) with supporting evidence.

Part 2: Agitation and Sedation Assessment and Management

Comprehensive sedation assessment (RASS, SAS complete scoring tables), light sedation targets, sedative agent pharmacology and dosing (propofol, dexmedetomidine, midazolam, ketamine), propofol infusion syndrome, daily sedation interruption protocols, and nurse-driven sedation algorithms.

Nutrition in Critical Illness — Part 2: Enteral Nutrition

Comprehensive guide to enteral nutrition in the critically ill: timing of initiation, gastric vs post-pyloric access, advancement protocols, formula selection, gastric residual volume management, prokinetic agents, complications including aspiration and refeeding syndrome, and EN during prone positioning and vasopressor therapy.

Acute Stroke Management — Part 2: Intravenous Thrombolysis

Alteplase and tenecteplase dosing, complete inclusion/exclusion criteria for 0-3h and 3-4.5h windows, blood pressure management peri-thrombolysis, orolingual angioedema, and hemorrhagic transformation.

Acute Airway Management & RSI — Part 2: RSI Protocol & Medications

Complete RSI protocol including preparation, pretreatment agents, induction agents with dosing tables, neuromuscular blocking agents with contraindications and reversal, paralysis verification, post-intubation sedation, confirmation of intubation, awake intubation, and drug-assisted intubation without paralysis.

Transfusion in Critical Care — Part 1: Red Blood Cell Transfusion

Evidence-based hemoglobin thresholds for RBC transfusion in the critically ill, landmark trial evidence (TRICC, TRISS, FOCUS, TITRe2, TRICS-III), physiologic triggers, single-unit policy, compatibility testing, and storage considerations.

Part 1: Definitions, Epidemiology & Pathogenesis

CLABSI and CRBSI definitions, NHSN surveillance criteria, mucosal barrier injury CLABSI, epidemiology by ICU type, attributable mortality and costs, pathogenesis of catheter colonization, microbiology, and risk factors.

Part 1: ARDS Definition and Initial Ventilator Setup

Berlin criteria for ARDS severity classification, initial ventilator mode selection, lung-protective tidal volume targets, ideal body weight calculations, plateau and driving pressure limits, ARDSNet PEEP/FiO2 tables, respiratory rate management, and permissive hypercapnia.

Part 1: ABCDEF Bundle Overview & Pain Assessment and Management

The ABCDEF bundle framework for ICU liberation, comprehensive pain assessment tools (BPS, CPOT, NRS) with complete scoring tables, and evidence-based analgesic management including opioid dosing, non-opioid adjuncts, and multimodal protocols.

Oncology Clinical Guidelines

Comprehensive, evidence-based clinical guidelines for oncology practice — synthesized from multiple professional society recommendations covering vascular access, supportive care, safety, pain management, immunotherapy, and survivorship.

Oncology

Comprehensive, evidence-based clinical guidelines for oncology practice — vascular access, supportive care, safety, pain management, immunotherapy, and survivorship.

Part 4: Complication Prevention and Management

CLABSI prevention and treatment, catheter-associated thrombosis, occlusion management, extravasation, catheter malposition, pinch-off syndrome, and catheter damage in oncology CVAD patients.

Part 3: Catheter Maintenance Protocols

Flushing and locking protocols, dressing change procedures, needleless connector management, port access and deaccess procedures, blood sampling, and patency assessment for CVADs in oncology patients.

CINV Guideline — Part 3: Recommended Antiemetic Regimens and Special Populations

Guideline-recommended antiemetic regimens by emetogenic risk level, multi-day chemotherapy protocols, oral chemotherapy CINV, radiation-induced nausea and vomiting, breakthrough and refractory CINV management, and considerations for pediatric, geriatric, and organ-impaired populations.

Part 2: Insertion Techniques and Site Care

Insertion site selection, ultrasound-guided placement, tip confirmation, skin antisepsis, dressing and securement, and site care protocols for central venous access devices in oncology patients.

Febrile Neutropenia — Part 2: Empiric Antibiotic Therapy & Outpatient Management

Empiric intravenous antibiotic monotherapy and combination regimens with complete dosing, indications for vancomycin and anti-gram-positive agents, antibiotic de-escalation and duration criteria, outpatient eligibility for low-risk febrile neutropenia, oral antibiotic regimens, and monitoring requirements.

Part 1: Device Selection and Patient Assessment

CVAD types and oncology-specific indications, patient assessment framework, vein selection in cancer patients, device selection algorithms, and special population considerations for central venous access in oncology.

Vascular Access Guidelines

Professional organization guidelines for vascular access practice — AVA Clinical Practice Guidelines and more.

AVA Clinical Practice Guidelines

Association for Vascular Access (AVA) Adult Clinical Practice Guidelines — JAVA January Supplement 2026, Volume 31. Evidence-based recommendations for vascular access practice.

AVA CPG 2026 — Part 5: Glossary of Terms

Association for Vascular Access Adult Clinical Practice Guidelines (JAVA 2026, Vol. 31) — Part 5: Comprehensive glossary of vascular access terminology and definitions referenced throughout the guidelines.

AVA CPG 2026 — Part 1: Guideline Development, Foreword & Introduction

Association for Vascular Access Adult Clinical Practice Guidelines (JAVA 2026, Vol. 31) — Part 1 covering guideline development, acknowledgments, foreword, introduction, and Sections 1–2: Infrastructure, Teams, Clinical Foundations, and Patient Assessment.

Handbook for Infection Prevention Guideline Development

A comprehensive methodology handbook for developing clinical guidelines, expert guidance documents, consensus statements, and practice statements in infection prevention and healthcare epidemiology. Covers proposal processes, systematic literature review, evidence grading, consensus methods, and development timelines.