News
Clinical Voices July 2026
Jul 27, 2026
SCCM Guidelines on ICU Care of Older Adults
The panel offers recommendations on caring for older adults during and after ICU stays.
Guidelines for older adults in the ICU call for geriatric informed care strategies, while pointing to evidence gaps and highlighting priority areas for research to strengthen care for this growing population.
“Society of Critical Care Medicine [SCCM] Guidelines on Caring for Older Adults in the ICU,” in Critical Care Medicine, presents two conditional recommendations and three areas where evidence was insufficient to guide practice. The 22-member panel included physicians, advanced practice providers, nurses, a pharmacist, physical and occupational therapists, and a patient representative.
The panel suggests using a geriatric model of care for older adults (ages 65 and older), noting small but potentially meaningful benefits in delirium reduction and functional outcomes despite very-low certainty evidence. They also advise against antipsychotic medications for delirium prevention, citing uncertain benefits and heightened vulnerability to medication related harm.
The panel has no recommendations for three additional questions, because available evidence is inconsistent or indirect. These unresolved areas include whether older ICU survivors should receive specialized post ICU follow up, whether targeting a MAP of 60-65 mm Hg is preferable in vasodilatory shock, and whether antipsychotics should be used to manage delirium in patients who already have the condition.
Older adults bring distinct challenges to the ICU, including frailty, polypharmacy, and a heightened risk of delirium, especially with cognitive impairment. These factors can shape outcomes as much as the underlying illness, and SCCM’s guidelines highlight major research needs, particularly studies on functional recovery, cognitive trajectories and the effectiveness of geriatric-informed care models.
To support nurses who care for older adults, AACN offers several resources, including an NTI recorded session on traumatic injury that reviews age related pathophysiological changes, risk factors and best practices in managing geriatric trauma. An article in American Journal of Critical Care describes a rhythmic electrocardiographic pattern that can support assessment of complex cardiac presentations in older adults.
New Guidelines for Pediatric End of Life Care
A multidisciplinary panel developed the guidelines by reviewing research published from 2000 to 2025.
Recognizing that end of life (EOL) care for critically ill children is among the most complex challenges in pediatric intensive care, new guidelines give ICU teams a structured, evidence based approach to support families, ease suffering and improve communication.
“Society of Critical Care Medicine [SCCM] 2026 Guidelines on the Care and Management of Pediatric and Neonatal Intensive Care Patients at the End of Life,” in Pediatric Critical Care Medicine, addresses a major need for standardized, ICU specific guidance for infants and children, where practice is often inconsistent and emotionally demanding.
A 21-member multidisciplinary panel developed the guidelines by reviewing research published from 2000 to 2025 and using the GRADE approach to rate evidence and form recommendations. Their review led to five conditional recommendations:
- Implement advance care planning, because studies show it can improve parental preparedness and reduce perceived suffering.
- Consult pediatric palliative care teams to strengthen communication, decision-making and clinician coping.
- Use structured approaches to symptom assessment and management to better align care with family goals.
- Provide palliative care education for ICU staff to improve communication skills and reduce moral distress.
- Implement a bereavement care process that includes counseling, memory-making activities and follow-up support for families.
The panel also issued a good practice statement to address disparities in pediatric EOL care by recognizing bias, reducing structural barriers and engaging marginalized communities.
“These 2026 SCCM guidelines underscore the critical need for continued research to strengthen the evidence base for EOL care in pediatric and neonatal intensive care settings.” Future studies will help clarify which approaches improve outcomes and support patients and families. Emerging tools and study designs can help make that progress possible, the study notes.
A related article in American Journal of Critical Care examines ICU nursing care for children with cancer at EOL, including communication, symptom support, family needs and decisions about life sustaining therapies.
Online Therapy and Reducing Stress After Pediatric Trauma
The online format may reduce barriers to treatment and improve access.
An online interactive therapy course with virtual sessions reduced the severity of post-traumatic stress symptoms (PTSS) in children who had been hospitalized with physical injuries.
“Reducing Stress After Trauma in Physically Injured Children: A Randomized Clinical Trial,” in JAMA Pediatrics, describes an eight-session cognitive behavioral therapy program, Reducing Stress After Trauma (ReSeT), that lowered symptoms in discharged patients ages 8 to 17. “Findings of this randomized clinical trial reveal that the ReSeT program was an effective, brief, trauma-focused intervention for reducing PTSS after physical injury,” the trial concludes.
Recruited from four level 1 pediatric trauma centers between 2021 and 2024, 93 participants were randomized, with 47 in the ReSeT cohort and 46 receiving usual care. Most of the children were injured in vehicle crashes or through sports or recreation.
Child Posttraumatic Stress Disorder Scale scores reported by both patients and their parents had a lower adjusted average of 4.2 points after 10 weeks (14.7 for usual care vs. 10.5 for ReSeT participants) and 5.5 points after six months (13.5 vs. 8.0). “Exploratory analyses using separate child and parent report and sensitivity analyses corroborated the primary findings using the combined parent and child ratings.”
ReSeT participants received an average of 5.3 hours of therapist contact in addition to completing online modules. “The online format may reduce barriers to treatment and improve access in rural and other underserved communities,” the trial adds.
The trial’s limitations include a small sample size after reducing the eligible participant group from 722 to 93 and an imbalance in age and gender populations in the randomization (notably, a relative lack of teenage girls in the ReSeT arm).
AACN resources include Navigating the Complexities of Pediatric and Neonatal Care, a webpage that includes a resource to assess and manage pediatric trauma.
Central CRT Predictive of Mortality Risk
Even patients with normal HR and BP but longer central CRT had a higher 28-day mortality risk.
Adult patients with trauma-related injuries had an increasingly higher risk of mortality the longer their central capillary refill time (CRT), which was measured on the sternum.
“Association of Central Capillary Refill Time With Mortality in Adult Trauma Patients: A Secondary Analysis of the CRASH-2 Randomised Controlled Trial Data,” a retrospective observational analysis in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, notes that even patients with normal heart rate and blood pressure (not in shock) but longer central CRT showed an elevated 28-day mortality risk. “Thus, prolonged CRT can reveal hidden hypoperfusion, making it a more sensitive marker in certain clinical contexts,” the analysis concludes.
Using data from 19,054 patients in the CRASH-2 trial, which covered 274 hospitals in 40 countries from 2005 to 2010, the analysis divided CRT times into multiple types of subgroups and determined that patterns of increasing risk remained throughout. “Higher CRT was also associated with an increased likelihood of blood transfusion, surgical intervention and thromboembolic events.”
Patients with a CRT of less than or equal to two seconds formed the baseline (35.5% of the total population), and the odds of death increased to a ratio of 1.7 for CRT of three to four seconds and a ratio of 3.2 for CRT of five seconds or higher. When analyzed linearly, the data also showed a steady predictive ability for mortality, from 7% for patients with CRT for one second to 25% at six seconds.
Defined as “the time taken for a skin capillary bed to regain its colour after sufficient pressure has been applied to cause blanching,” CRT can be a marker of impaired circulation and is commonly used in pediatric trauma cases. Analysis limitations include a predominantly young, male population, a lack of short-term outcome analysis and an inability to draw a direct clinical connection between longer CRT and patient deaths, the analysis adds.
ICP Thresholds for Pediatric Patients With TBI
Findings suggest that the 20 mm Hg threshold may be too high for pediatric patients.
Intracranial pressure (ICP) thresholds of 14 to 15 mm Hg in pediatric patients with traumatic brain injury (TBI) were associated with better functional outcomes, challenging a current standard of care.
“Intracranial Pressure Treatment Thresholds in Pediatric Traumatic Brain Injury,” in JAMA Pediatrics, notes that patients with sustained ICP above the 14 to 15 mm Hg threshold faced increasing odds of poor outcomes, thus leading to questions about the 20 mm Hg adult standard frequently applied to pediatric patients.
“In this context, our findings suggest that rigid universal application of a single 20 mm Hg treatment threshold across the pediatric age range may merit reconsideration as the evidence base evolves, and that effective and timely ICP control, rather than treatment escalation alone, underpins improved prognosis,” the study notes.
Using data from the Studying Trends of AutoRegulation in Severe Head Injury in Pediatrics (STARSHIP) research database, the study included 135 patients ages 16 and younger requiring ICP monitoring in pediatric ICU settings, in the United Kingdom, who had a median age of 8 years and no one younger than 8 months. “Sustained ICP greater than 15 mm Hg remained a prognostic factor for poor functional outcome at 12 months, a finding complemented by propensity score matching and causal modeling,” the study adds.
One limitation due to the study size is difficulty assessing whether critical thresholds adjust by age. Taken as a whole, however, the data suggests that the 20 mm Hg threshold may be too high for pediatric patients, the study adds.
“As all measurements were obtained under active management targeting ICP less than 20 mm Hg, it is important to distinguish whether ICP elevation reflects underlying injury severity, therapy failure or a truly modifiable secondary brain injury.”
AACN clinical resources include Navigating the Complexities of Pediatric and Neonatal Care, a webpage that offers evidence-based knowledge on an array of topics, including trauma assessment and management.
Off the Shelf Alternative for Coronary Artery Bypass Shows Promise
A collagen-based conduit may be an off-the-shelf alternative to CABG.
The first in-human study of an engineered vessel for coronary artery bypass grafting (CABG) finds that two implanted grafts avoided device-related problems and one remained fully open at 12 months, showing early promise for an off-the-shelf alternative to saphenous vein grafts.
“Clinical Evaluation of Completely Biological Engineered Vessel for Coronary Artery Bypass,” in JACC: Case Reports, introduces the acellular tissue engineered vessel with an external support structure (ATEV ESS), a collagen based conduit designed to address the durability and availability limitations of current bypass options. The device is engineered to hold its shape and gradually repopulate with the patient’s own cells.
The Vascular Conduit for Arterial Bypass 1 (VCAB 1) study enrolled three patients scheduled for multivessel CABG, with two ultimately receiving the ATEV-ESS and showing good early function.
In one patient, the graft later developed a proximal kink that impaired flow, a technical issue rather than a device related complication. In the second patient, the graft maintained smooth, stable perfusion for a full year and performed better than the saphenous vein graft, placed during the same surgery, which showed progressive stenosis.
In a related article in Cardiovascular Business, lead study author Adrian Ebner, a cardiovascular specialist, explains that prior attempts to create off the shelf conduits have repeatedly failed in small diameter coronary targets, because synthetic grafts struggle with thrombosis and fail to form a healthy inner lining.
“ATEVs represent a different paradigm: The vessels are designed to support host-mediated endothelialization and smooth muscle repopulation, enabling biological integration with the native coronary circulation while providing immediate availability,” Ebner adds in the article.
Larger studies are needed to confirm long term safety, durability and remodeling of the ATEV ESS in a broader CABG population, the study notes. Future work will focus on refining implantation techniques, improving length planning tools, and tracking how consistently the conduit repopulates with patient cells over time.
President’s Column: Every Voice. Every Story. Every Table.
New AACN President Tonka Williams reprises her NTI 2026 keynote address to unveil AACN's theme: "Every Voice. Every Story. Every Table." She shares experiences that helped her learn about belonging and mattering. "Belonging means you’re welcomed into the room. Mattering means your voice is expected, your expertise is trusted, and your presence makes a difference. Every nurse deserves both."
Life at the Bedside and on the Sideline
Camryn Sparrevohn balances life and tight schedules as a night-shift ICU nurse and a Los Angeles Rams cheerleader. “At the end of the day, I don't see them as two different jobs. I see them as two ways I get to help people.”