Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Front

1 of 3 · Front

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

In one breath

The 2021 Surviving Sepsis Campaign guideline (Domain 14 filing) — superseded by the 2026 edition per this record: immediate treatment, cultures before antimicrobials where feasible, an initial 30 mL/kg crystalloid for hypoperfusion with reassessment, and norepinephrine first-line.

Edition2021

Issued bySociety of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM)

Place of issueInternational

PublishedCritical Care Medicine · 2021;49(11):e1063–e1143

⚪ Superseded by Surviving Sepsis Campaign 2026 edition

FACE COLOURS Front — the summary · Back 1 — what it covers + key recommendations · Back 2 — evidence, changes + source

Back 1

2 of 3 · Back 1

Back colours mark the reading sections — the chapter colour is the band and chip.

§1 · What it covers

This guideline covers adult sepsis and septic shock in hospital care, with prehospital and post-hospital elements; resuscitation, antimicrobials, source control, organ support, ICU care, and stewardship.

Applies to: Adults with sepsis or septic shock; not a pediatric guideline and not specific to one surgical diagnosis.

§2 · Key recommendations

Immediate recognition and treatment.
obtain cultures before antimicrobials when feasible.
administer antimicrobials immediately/ideally within one hour for septic shock or high-likelihood sepsis.
use crystalloid as first-line fluid.
initial 30 mL/kg crystalloid for sepsis-induced hypoperfusion/septic shock with reassessment.
norepinephrine as first-line vasopressor.
dynamic measures to guide further fluids.
early source control when required.
de-escalate antimicrobials when microbiology and clinical status permit.
avoid routine IV vitamin C, probiotics, and restrictive approaches unsupported by evidence.
The 2021 document also supported balanced crystalloids over 0.9% saline in many patients, individualized oxygen/ventilation and renal-replacement decisions, and early enteral nutrition when appropriate.

FACE COLOURS Front — the summary · Back 1 — what it covers + key recommendations · Back 2 — evidence, changes + source

Back 2

3 of 3 · Back 2

Back colours mark the reading sections — the chapter colour is the band and chip.

§3 · Evidence & grading

GRADE; recommendations are strong or weak/conditional with high, moderate, low, or very-low certainty. Many time-critical sepsis actions have low or very-low certainty despite strong recommendations; this reflects feasibility and indirect evidence rather than high-quality trials.

§4 · What changed in this edition

Not yet established — pending verification.

§5 · Source & working link

Evans L, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063–e1143 · PMID 34605781.

Publisher — the record's original_url, carried verbatim ↗PubMed — PMID 34605781 ↗

Link check 2026-11-11: the publisher (SCCM campaign) URL fetched live — HTTP 200; the PubMed record (PMID 34605781) fetched live — title, journal, volume and pages match the record.

Source: Tamer-supplied guideline index, intake 2026-11-10 (record #149, Domain 14) · Card built 2026-11-11 (Wave D) from the record itself; the §5.2 verification pass (UpToDate + Medscape → Perplexity → Tamer decision) has not yet run on this card. ⚑ Conflict flag on the source record — documented cross-society disagreement (intake DOCX Table 2): Sepsis — SSC 2021 vs SSC 2026. This record's own evidence note states the point: the 2021 '30 mL/kg' approach was more prescriptive than the 2026 wording, which retains at least 30 mL/kg as a suggestion with stronger emphasis on individual characteristics and repeated reassessment. Unresolved — pending the verification pass (UpToDate + Medscape → Perplexity → Tamer decision).

FACE COLOURS Front — the summary · Back 1 — what it covers + key recommendations · Back 2 — evidence, changes + source

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