Below is a comprehensive summary of the key changes in the SSC 2026 Guideline, analyzed from a clinical practice perspective for emergency medicine physicians.
1. Screening and Diagnostic Tools
- New point: RecommendationUSE NEWS, NEWS2, MEWS, or SIRSinstead of qSOFA as a standalone screening tool.
- Reason:qSOFA has too low sensitivity. NEWS2 achieves a sensitivity of 73.1% and a specificity of 81.6%, minimizing the risk of missing patients despite a higher false positive rate.
- Probability stratification:Divided into 4 levels: Definite, Probable, Possible, and Unlikely.
2. Individualized Antibiotic Strategy
- In shock:Administer antibiotics immediately (≤ 1h) for all levels from Definite to Suspected.
- Not in shock:
- Definite/Probable: Antibiotics within 1h.
- Possible: Quick assessment, if still suspected then administer within ≤ 3h.
- Unlikely: Delay, closely monitor, and search for other causes.
3. Fluid Resuscitation and Vasopressors
Fluid resuscitation:Maintain ≥ 30 ml/kg in the first 3h but emphasizecontinuous reassessmentto avoid fluid overload. Prioritize dynamic tests such as PLR, SVV, PPV.
Target MAP:General is 65 mmHg. Patients ≥ 65 years may accept a level of 60–65 mmHg (permissive hypotension).
Vasopressors:Noradrenaline is the first choice.
- Early combination of Vasopressin when Norad reaches ~0.3 µg/kg/min.
- Administer Noradrenaline IMMEDIATELY alongside fluid resuscitation if shock is unstable (severe hypotension, mottled skin...).
4. Supportive Therapy: Hydrocortisone and Methylene Blue
Hydrocortisone:Remove the old rigid dosing threshold (0.25 µg/kg/min). Early use decision (200mg/day) based on clinical response and continuous increase in vasopressor dose.
Refractory shock:ConsiderMethylene Blueas a rescue therapy in severe vasodilatory shock resistant to vasopressors to inhibit NO, increase vascular tone.
5. Recovery Phase: Active Fluid Removal
Active fluid removal:This is an extremely important point. After the resuscitation phase, when vasopressor escalation has stopped, active fluid removal is needed through diuretics or ultrafiltration.
Reason:Fluid overload causing tissue edema reduces tissue oxygenation, directly leading to multiple organ failure.
6. Other Important Changes
- Antipyretics:Not used to improve mortality, only used to relieve pain/symptoms.
- Probiotics:DO NOT USE due to lack of clinical benefit.
- Vitamin C:DO NOT USE (Stronger recommendation due to risk of harm).
- Gastric ulcer prophylaxis:Prioritize using PPIs for high-risk gastrointestinal bleeding groups.
Reference citation: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Critical Care Medicine (2026). DOI: 10.1097/CCM.0000000000007075.
📂 DOCUMENT LIBRARY: Full text of SSC 2026 Guideline & Vietnamese summary
