News
Clinical Voices August 2026
Aug 28, 2026
Clinical Practice Guidelines for New-Onset POAF After Cardiac Surgery
A committee of cardiac specialists reviewed years of evidence to develop 15 recommendations.
New clinical practice guidelines on new-onset postoperative atrial fibrillation (POAF) offer the most complete direction yet, giving clinicians a clearer framework while recognizing that evidence across preventive and intraoperative strategies still varies and requires careful consideration of each patient’s risk.
“The Society of Thoracic Surgeons 2026 Clinical Practice Guidelines for the Prevention and Treatment of New-Onset Postoperative Atrial Fibrillation After Cardiac Surgery,” in The Annals of Thoracic Surgery, notes that medication studies on preventing or managing POAF lack clear guidance on dose and timing. Intraoperative strategies are also evolving, highlighting the need for more consistent practice and clearer research priorities.
A related article in Cardiovascular Business notes that new-onset POAF is the most common complication after cardiac surgery, often appearing within four postoperative days. Although POAF often resolves on its own, it is linked to longer hospital stays, higher costs and increased long term risks for patients. A committee of cardiac specialists reviewed years of evidence on POAF, including incidence, risk factors and outcomes, to develop 15 evidence-based recommendations for prevention and management.
The recommendations include options such as perioperative oral amiodarone and beta blockers, along with electrical cardioversion when patients become hemodynamically unstable. The guidance also outlines options for stable POAF, including rate versus rhythm control and decisions about anticoagulation across preventive, intraoperative and postoperative strategies.
“Whereas several existing atrial fibrillation guidelines address POAF only briefly, this document serves as a focused, current and comprehensive resource specifically dedicated to guiding its prevention and treatment after cardiac surgery,” notes the related article.
The guideline committee concludes that preventive strategies, close rhythm monitoring and individualized anticoagulation can help reduce POAF risk. Future progress will require multidisciplinary collaboration and stronger evidence to refine prediction tools, clarify modifiable factors and improve measurement of the arrhythmia burden.
PICU Sedative Strategy May Impact Cognitive Development
A future randomized trial could develop evidence-based guidelines based on these findings.
The sedative strategy for pediatric ICU patients with acute respiratory failure could have a long-term impact on cognitive development, although most children had normal-range IQ scores five years later.
“Sedative Choice and Neurocognitive Outcomes After Critical Illness in Early Childhood,” a prospective, cohort follow-up study in JAMA Network, shows that children whose sedation strategy included dexmedetomidine had slightly higher IQ scores than patients with a different strategy.
“Children who received an opioid- and benzodiazepine-only strategy scored lower than those who received a strategy that included dexmedetomidine when controlling for socioeconomic status, illness severity, and duration of mechanical ventilation,” the study adds.
The study involved follow-up neurocognitive testing for 247 children ages 5 to 9 approximately five years after ICU sedation for acute respiratory failure. Patients on an opioid- and benzodiazepine-only strategy had the lowest mean estimated IQ at follow-up (98.3), followed by patients on multiple sedative classes without dexmedetomidine (100.6) and patients on multiple sedative classes including dexmedetomidine (101.9).
Acknowledging the overall positive news that children recovering from lengthy pediatric ICU stays maintained normal cognitive function on average, the study also sees potential vulnerability based on clinical decisions: “While the children’s estimated IQ was similar to the test mean, the children demonstrated lower scores in multiple cognitive domains that may be associated with the child’s academic performance, play, development and emotional well-being, interpersonal relationships, and completion of daily activities.”
The study’s limitations include a lack of prehospitalization assessment of cognitive ability, the exclusion of children with neurocognitive dysfunction and the inability to test some children at follow-up, who “may be expected to have lower test scores.” A future randomized trial could build on these findings to develop evidence-based guidelines, the study adds.
Standardizing Nurse Residency Programs for Retention, Growth
NLNs who participate in residency programs are more likely to stay in their jobs longer than nonparticipants.
A multistate healthcare system standardized its nurse residency programs to optimize the transition to practice for newly licensed nurses (NLNs), to increase retention and professional growth.
“How a Large Healthcare System Standardized Its Nurse Residency Programs,” in American Nurse, notes that combining several legacy approaches into a unified, deliberate curriculum created an opportunity to enhance support for nurses.
“This standardized approach also aimed to serve as a catalyst for nursing excellence, including bolstered nurse recruitment and retention, heightened NLN competence in clinical skills and critical thinking, and smoother assimilation into the profession and the health system,” the article adds.
After assessing all the system’s existing strategies and surveying stakeholders to rank topics by significance, a committee built a final revised curriculum that achieved internal goals and met accreditation standards. A biannual review process involves content revision and updates on current practice and evidence, with additional reviews as needed; significant savings have been achieved.
The system also tracks participant feedback and course satisfaction, with attention on stress and burnout levels. “Stakeholder survey results demonstrated that increased support and collaboration, particularly in interprofessional teamwork, correlated with gains in clinical performance, confidence and competence among NLNs.”
AACN resources include the New Nurse Orientation Pathway , which helps organizations build personalized experiences to meet new nurses’ educational requirements and Navigating the Complex Practice Readiness Journey , a partnership opportunity between AACN and other organizations to help ensure nurses transition into practice effectively.
AACN blogs supporting orientation and transition to practice include the following:
- Resurrecting an NLN to ICU Transition Program – Filling the Void
- Rethinking Critical Care Orientation
- Building Confidence: 10 Orientation Learning Goals for Novice Nurses
- 5 Creative Tips for Improved Learning in the Flipped Classroom
- Five Ways to Engage and Involve New Nurses in the Flipped Classroom
- Supporting Novice Nurses Post-Orientation Through TeleICU
Guideline: Excess Weight and Cardiovascular, Kidney Health Risks
The new guideline recommends routine assessment of CKM risk factors for all adults.
The increasing attention on cardiovascular kidney metabolic (CKM) syndrome helped lead to new guidance that identifies excess body weight as a major modifiable driver and urges early CKM staging and structured risk assessment to protect patients’ long-term cardiovascular and kidney health.
“2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome,” in Circulation, notes that “routine assessments for metabolic risk factors and kidney function are recommended among all adults, as well as selected assessments for pre-HF [heart failure], metabolic dysfunction-associated steatotic liver disease (MASLD), and obstructive sleep apnea (OSA) in subsets of individuals.”
This first-ever guideline on CKM syndrome recommends assessing adults for excess weight, including obesity and abdominal adiposity, to better characterize risk. Use of the PREVENT equation is encouraged to estimate long term cardiovascular risk and guide treatment for patients. Coordinated care across cardiology, nephrology and endocrinology is emphasized to support timely use of cardioprotective and kidney protective therapies.
A related article from the American Heart Association and the American College of Cardiology says the guideline gives clinicians a clearer basis for talking to patients about excess weight as a health risk rather than a cosmetic concern. It also explains that defining CKM syndrome as a connected framework helps recognize how obesity, metabolic dysfunction and kidney impairment interact to drive cardiovascular risk.
“The guideline includes proven strategies to support healthy lifestyle practices as the foundation of CKM syndrome management,” adds committee chair Chiadi Ndumele in the related article. “It also outlines the use of increasingly effective medications that benefit multiple body systems. These include SGLT2 inhibitors, GLP-1 based therapies and nonsteroidal mineralocorticoid receptor antagonists.”
An at-a-glance version of the guideline in Journal of the American College of Cardiology presents 10 take home messages and a series of key recommendations in a streamlined format without the full narrative detail of the primary report.
Improving Chest Tube Decisions on Thoracic Trauma
Computed-tomography based measurements can estimate hemothorax volume and support decisions on when to drain.
Treating patients with traumatic thoracic injuries usually means managing pneumothorax or hemothorax, and recommended practice calls for rapid tube thoracostomy in unstable patients while using imaging to determine which stable patients need drainage and which can be observed safely.
“Traumatic Pneumothorax and Hemothorax: What You Need to Know,” a review in The Journal of Trauma and Acute Care Surgery, outlines how computed-tomography based measurements can estimate hemothorax volume and support timely decisions on when to drain. It adds that draining collections larger than 300 mL, administering antibiotics before tube placement and irrigating with warm sterile saline may reduce complications and lower the need for repeat procedures.
Delayed recognition or inadequate drainage can increase the risk of respiratory deterioration and additional interventions, the review notes, emphasizing the importance of close follow up after tube placement to identify treatment failure early and reduce avoidable morbidity.
A related article in Current Problems in Surgery widens the view, noting that about one-third of patients with thoracic trauma are diagnosed with a pneumothorax, hemothorax or hemopneumothorax, which rises to about 75% when rib fractures are involved. Choosing the best treatment for patients remains difficult, with failure rates that often lead to more invasive intervention despite early recognition and initial drainage efforts.
The article explains that observation, tube thoracostomy and surgery remain the main treatment options, and decisions often hinge on how the injury occurred, the patient’s physiology and what imaging shows. It also highlights ongoing work to refine care, including studies on small bore catheters, thoracic lavage, early video-assisted thoracoscopic surgery for retained collections and clearer criteria to identify patients who can be observed safely.
An AACN blog describes how nurses can feel more confident managing chest tubes, particularly when care is complex or not routinely encountered. The blog highlights just in time training and checklists as practical tools to help make management easier and less intimidating.
Long-Distance Robotics Help Perform Cardiac, Stroke Surgeries
Each new remote procedure pushes the boundaries of telesurgery.
Surgeons have demonstrated the ability to perform long-distance robotic stroke and cardiac procedures on patients who otherwise might lack access to lifesaving care.
For instance, a surgeon in Guyana performed a left internal mammary artery takedown on a patient in India, thousands of miles away, thanks to high-speed fiber communications and a surgical robotic tool, notes “Longest-Distance Robotic Cardiac Telesurgery Ever Performed Over 12,500 Miles,” in Cardiovascular Business. So far, the SSi Mantra system has been used remotely in 22 cardiac surgeries and 173 total surgeries.
The robotic system mimics the surgeon’s hand movements with a network latency of 290-300 milliseconds. “With each new remote procedure, we continue to push the boundaries of telesurgery and move closer to democratizing access to world-class surgical expertise globally,” adds Dr. Sudhir Srivastava, who performed the surgery.
Another procedure, performed by a surgeon on a patient in Panama who was 120 miles away, required only one pass to remove a clot after a stroke. According to “World’s First Telerobotic Neurosurgery Performed on Stroke Patient 120 Miles Away ,” also in Cardiovascular Business, the XCath Iris Surgical Robotic System allowed the surgeon to “perform mechanical thrombectomy utilizing a stent retriever and balloon occlusion with dual aspiration.”
Because the patient could not receive immediate stroke care in their location, the remote procedure put them on a course for full recovery. “XCath has accomplished what no other company has achieved in stroke care: a successful remote robotic mechanical thrombectomy delivering lifesaving treatment to a patient that would have otherwise not been able to receive treatment,” XCath Chairman Fred Moll says in the article.
The article adds that XCath has not yet received approval from a regulatory agency, including the U.S. Food and Drug Administration. “On behalf of the people of Panama, we proudly celebrate this milestone and the global hope it represents for patients and families affected by stroke,” Jose Raul Mulino, president of Panama, says in the article.
President’s Column: Self-Care & Belonging – The Courage to Be Present for Yourself
AACN President Tonka Williams explores self-care and belonging, and taking time to be present for yourself. "Quiet moments remind me that healing doesn't always happen in giant leaps. Sometimes it begins by believing you are worthy of your own time and attention.”
Painting a Path to Well-Being
Outside the hospital, ICU nurse Luis Mota Besa Jr. finds balance with a paintbrush in hand. This creativity has become a meaningful outlet that helps him recharge and process the emotional demands of critical care. In this Q&A, Luis shares how nursing and art complement each other and why finding a creative outlet is essential to maintaining well-being on and off the job.