2025 national clinical huideline for sepsis in children

This article is an adapted version of the federal clinical guidelines on sepsis in children, developed by the specialists of the Association of Pediatric Anesthesiologists and Intensivists of Russia and approved by the Ministry of Health of the Russian Federation on October 10, 2025. Definitions of sepsis and septic shock in pediatric patients are substantiated, including their criteria. Data on etiology and pathogenesis, epidemiology, clinical presentation, and diagnosis of shock are presented. Recommendations for intensive care management of sepsis and septic shock include sections on antimicrobial therapy in pediatric sepsis, hemodynamic, respiratory, and nutritional support, renal replacement therapy and extracorporeal blood purification, and adjuvant therapy. It also discusses controversial issues related to the use of immunomodulatory agents, corticosteroids, and vitamins. The work emphasizes that in children with septic shock, antimicrobial therapy should be initiated no later than 1 hour after diagnosis, whereas in the absence of shock it should be started no later than 3 hours after diagnosis. It is noted that infusion therapy in children with septic shock during the first hour after diagnosis should not exceed 40 mL/kg in order to prevent fluid overload, with balanced crystalloid electrolyte solutions recommended as first-line agents for volume resuscitation. In septic shock, norepinephrine and epinephrine are the drugs of choice for hemodynamic correction, whereas dopamine is not recommended. It is demonstrated that septic shock and severe acute respiratory distress syndrome are absolute indications for invasive mechanical ventilation using lung-protective strategies. The importance of early initiation of enteral nutrition in children with sepsis and septic shock is emphasized; it is considered justified even during infusion of inotropic agents provided that hemodynamic parameters are stable. Renal replacement therapy is indicated not only for substitution of renal function but also for correction of fluid overload when diuretic therapy is ineffective. Convincing evidence is presented that the use of plasma exchange and sorption techniques in children with sepsis and septic shock is currently not recommended. It is noted that hydrocortisone therapy in children with sepsis is justified only in refractory septic shock. Modern principles of metabolic management in sepsis are described, indicating that optimal blood glucose levels in children should not exceed 7.8 mmol/L; insulin therapy is justified when blood glucose levels exceed 10 mmol/L. Data on rehabilitation, prevention, and organization of medical care for pediatric sepsis are also provided.