Update der S3-Leitlinie Sepsis 2025 – was ist neu?

Abstract The recently revised German Sepsis Guideline 2025 reflects an increasing integration of personalised therapy principles. This trend is observed in key recommendations relating to early recognition, anti-infective therapy, hemodynamic support, and organ-protective strategies. Early detection should be performed using validated screening instruments. Additionally, antibiotic therapy must be adapted to the individual patient, with administration ideally starting within one hour in cases of septic shock and no later than three hours in sepsis without shock. The guideline further emphasises timely diagnostics and hemodynamic stabilisation. Lactate measurement remains mandatory, while capillary refill time is additionally recommended. Norepinephrine remains the first-line vasopressor, with vasopressin as an additive option, and peripheral administration is allowed until a central venous catheter has been inserted. In parallel, the recommendations on ventilation strategies have been adjusted to optimise lung-protective management, advising a tidal volume of 6 ml/kg ideal body weight, with a range of 4–8 ml/kg in ARDS, and a driving pressure not exceeding 14 cmH2O. Prone positioning is recommended for at least 12 hours, preferably 16 hours.Regarding organ support, the guideline suggests continuous modalities of renal replacement therapy with effluent rates of 20–25 ml/kg/h, while also supporting a watchful waiting approach if urgent indications are absent. Furthermore, the scope of adjunctive therapies has been refined. High-dose vitamin C and non-specific hemoadsorption procedures are not encouraged, whereas corticosteroids are indicated in patients with persistent vasopressor requirements, preferably hydrokortisone ± fludrokortisone if feasible. Finally, the guideline highlights the importance of follow-up and prevention of post-intensive care syndrome and the establishment of structured aftercare programmes.