News
Clinical Voices June 2026
Jun 16, 2026
2026 Sepsis Guidelines Refine Patient Care for All Ages
Sepsis guidelines were updated for adult and pediatric patients since the 2021 and 2020 versions, respectively.
“Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026,” in Critical Care Medicine, updates the 2021 adult guidelines with 129 total statements, including 46 that are new and more definitive guidelines. They emphasize hospital readiness through performance-improvement programs and team-based code sepsis or sepsis huddle protocols. The update reinforces sepsis being identified through overall clinical assessment rather than any single biomarker or diagnostic test.
Antimicrobial recommendations clarify when therapy should begin in shock versus non-shock presentations, reinforce prolonged or extended infusion strategies for beta-lactam antibiotics, and reduce routine use of empiric antifungal therapy. Hemodynamic updates allow more flexibility after the initial 30 mL/kg fluid bolus, specify a blood pressure target range for older adults, and support either invasive or noninvasive monitoring based on the patient’s condition and available resources.
“Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026,” in Pediatric Critical Care Medicine, updates the 2020 pediatric guidelines with 61 total statements, including 20 new recommendations and 13 revised to reflect new evidence or clarify previous guidance. The update adopts the 2024 Phoenix criteria to define sepsis and septic shock and notes that only a few recommendations are supported by high- or moderate-certainty evidence.
Pediatric updates include guidance on screening, renewed emphasis on performance-improvement programs, and refined fluid-bolus targets that vary by resource level. The panel issued several “In Our Practice” statements to describe common approaches when evidence remains limited but expert consensus provides practical insight.
Recommendations on separate adult and pediatric pages offer statements with strengths and certainty of evidence. Each page highlights new and updated items with rationales for specific age groups.
In addition, AACN’s sepsis webpage features evidence-based sepsis resources, including bedside tools, quick-reference materials, a webcast on adult guidelines, a webcast on pediatric guidelines and guidance for timely interventions.
Adverse Events Minimal Following PIV Vasopressor Administration
A review of 49 studies determined that adverse events with PIV use were minimal.
A meta-analysis and review to determine whether peripheral intravenous (PIV) administration of vasopressors could diminish the need for central venous catheter (CVC) placement found a low rate of minor adverse events.
In “Incidence of Adverse Events in Peripheral Intravenous Vasopressor Use: A Systematic Review and Meta-Analysis,” in JAMA Network Open, minor adverse events following all PIV vasopressor administrations occurred in 2.3% of critically ill adults across all studies, with a 1.4% incidence of major adverse events for midline catheters and 0.0% for short PIV catheters.
“These observations suggest that with appropriate monitoring, short-term vasopressor administration via short PIV catheters placed in proximal veins may represent a safe alternative to CVCs, particularly when rapid initiation of therapy is required or when central venous access is not immediately available,” the review adds.
The review included 49 studies and 33,060 catheter placements, which enabled clinicians to avoid CVC placement in 59.7% of cases where they used PIV catheters. The review categorized pain at the injection site, local tissue swelling or edema, infiltration, extravasation, tissue cannulation, cellulitis and thrombophlebitis as minor adverse events and venous thromboembolism (VTE) and tissue necrosis as major ones.
The analysis found a wide range of adverse events across the studies with a notable increase since 2021 and the Surviving Sepsis Campaign, with the broader adoption of PIV administration and enhanced attention to reporting possibly explaining the upward trend.
As for the major events, “the apparent difference in VTE risk between midline and short PIV catheters may be explained by important confounders, including catheter dwell time, insertion site and catheter diameter.” Differences in rates of avoiding CVC placement came largely from factors such as clinical settings, illness severity and resource availability.
Related AACN resources include an article in Critical Care Nurse on guidelines for infusing vasopressors.
Updated SOFA-2 Score Improves Predictive Value
The statement offers new definitions and variables, and revised thresholds, on the severity of organ dysfunction.
An expert panel completed the first update to the Sequential Organ Failure Assessment (SOFA) score since 1996, adding definitions that reflect contemporary clinical practices, and revising scoring categories to improve predictability.
“Rationale and Methodological Approach Underlying the Development of the Sequential Organ Failure Assessment (SOFA)-2 Score: A Consensus Statement,” in JAMA Network Open, presents a methodological, international process that reviewed and revised scoring for the original six organ systems and considered adding immune and gastrointestinal dysfunction before declining to do so. “The complexity and lack of necessary data to validate a gastrointestinal score and the lack of suitable markers to identify immune dysfunction on a routinely measured and widely available basis precluded their inclusion within SOFA-2,” the statement notes.
SOFA-2 seeks to incorporate variables in common measurements from easily collectable means and identify the amount of organ support necessary to maintain those variables at acceptable levels in adult ICU patients, although it still does not cover pediatric patients. Organ support includes current practices such as noninvasive modalities, renal replacement therapy, and cardioactive drugs and devices.
The panel of 60 members representing 65 countries submitted the SOFA-2 methodology to databases covering 3.4 million patients globally across various settings to test its predictive validity. The six organ systems – neurological, cardiovascular, respiratory, hepatic, renal and coagulation – remain the same as the original system (SOFA-1), with scores ranging from 0 to 24.
When comparing SOFA-1 and SOFA-2 scores on the same data, the panel found that almost half of the patients received a reclassification. “While increasing organ dysfunction is clearly associated with mortality risk, it should be stressed that SOFA is primarily intended to describe organ dysfunction consistently across different settings and longitudinally, if required, rather than competing with mortality risk prediction scores for which more complex models already exist,” the statement adds.
Protecting Nurses’ Moral Agency Amid Rising AI
Nurses must play a central role in shaping how AI is built, implemented and monitored.
The development of artificial intelligence (AI) should strengthen nurses’ moral agency, because their judgment, empathy and ethical responsibility are essential for trustworthy patient care.
“What Does Moral Agency Mean for Nurses in the Era of Artificial Intelligence?” in The Hastings Center Report, emphasizes that nurses must play a central role in shaping how AI is built, implemented and monitored, because algorithms can subtly influence ethical reasoning and clinical judgment. Without nurse involvement and ongoing oversight, AI systems may have hidden biases and weaken the ethical foundations of patient centered care.
The article adds, “Nurses must be part of the design teams for AI systems, and they must be trained not simply to use AI tools but also to evaluate and interpret their recommendations within a broader ethical framework.”
When care decisions move beyond rigid protocols, nurses step into their role as moral agents, judging whether AI generated recommendations are appropriate for a patient’s goals, values and dignity. While AI can help shape treatment pathways, only a healthcare professional can determine when to follow them and when human ethical judgment must take precedence, the article adds.
Summarizing the article’s guidance, several themes emerge for how nurses can help guide responsible AI development:
- Join AI design and implementation teams.
- Evaluate AI recommendations critically, and question outputs that conflict with patients’ values.
- Monitor systems for bias, drift or opaque reasoning.
- Insist on transparency when AI informs documentation or decision making.
- Collaborate with ethicists, informaticians and patients to guide responsible use of AI.
- Stay vigilant about how AI affects clinical practice, and maintain the moral agency that guides patient care.
The article concludes that moral agency is essential for meeting nurses’ day-to-day patient responsibilities; that should not change regardless of AI.
“Rather, nurses and other health professionals must exercise their professional responsibility to ensure that AI systems are developed in a manner that enhances, rather than disrupts or supplants, the moral agency of health professionals.”
Daily Pillow Cover Changes
Replacing pillow covers every day led to a 4% weekly decrease in carbapenem-resistant Acinetobacter baumannii (CRAB) incidence among medical ICU (MICU) patients in a study aimed at minimizing the pathogen’s high mortality rates.
“Effect of Daily Pillow Cover Replacement on the Incidence of Carbapenem Resistant cinetobacter baumannii (CRAB)in the Medical Intensive Care Units (MICU): A Comparative Study,” in Antimicrobial Resistance & Infection Control, notes the incidence decreased from 5.89 cases per 1,000 patient-days preintervention to 2.5 during the intervention period.
“By addressing soft textiles, a traditionally overlooked environmental reservoir, this approach supports a more comprehensive, systems-based model of CRAB transmission prevention and may contribute to sustainable reductions in ICU-acquired CRAB infections,” the study adds.
The study included 152 patients at a single tertiary Korean hospital, with 108 patients included preintervention and 44 postintervention; the average MICU stay was 26 days. Mortality decreased during the intervention period from 63.9% to 50%, but the difference did not reach statistical significance due to the general severity of patient conditions, the study adds.
Most of the CRAB-positive specimens in the study came from sputum, leading researchers to believe that the nurse-led intervention targeted a likely potential infection source. “Daily pillow cover replacement is a low-cost, scalable and sustainable practice that can be integrated smoothly into routine nursing workflows without disrupting ICU operations or requiring specialized disinfectants or equipment.”
Noting that conditions in other ICUs could vary significantly, the study acknowledges its limitations. The research also did not examine the impact of daily pillow cover changes on the presence of other drug-resistant organisms.
Recommended future research includes a multicenter study and different intervals of linen changes, as well as application for patients with different illness severities. “The absence of randomization and potential residual confounding factors inherent to interrupted time-series designs may limit causal inferences,” the study adds.
Small Patch Offers Promise for Heart Repair Without Surgery
The patch’s ultra thin, foldable structure makes this minimally invasive approach possible.
A stem cell patch restores cardiac function and reduces scarring in preclinical testing, offering a glimpse at a future option for patients who are too fragile for open heart surgery.
According to the media release, “Mayo Clinic Researchers Identify a New Stem Cell Patch to Gently Heal Damaged Hearts,” the lab-grown, paper-thin patch applied through a small incision immediately begins supporting damaged tissue and new vessel growth. Surgeons use a biocompatible adhesive to secure the patch in place, reducing inflammation and preventing additional injury to the heart muscle.
For years, scientists have investigated stem cell strategies to restore injured heart tissue, yet many early techniques required open heart surgery, a procedure that was too risky for many patients. But by converting ordinary adult cells such as skin or blood cells into induced pluripotent stem cells, scientists can now use them for regenerative applications, the release notes.
Developed by the Mayo Clinic in collaboration with engineers at University of Nebraska Medical Center, the patch’s ultra thin, foldable structure makes this minimally invasive approach possible. That flexibility allows for targeted placement without the need for open heart surgery.
“The beauty of this design is that it can be folded like a piece of paper, loaded into a slender tube, and delivered precisely where it’s needed through a small incision in the chest,” explains Wuqiang Zhu, a cardiovascular researcher at the Mayo Clinic in Arizona.
The stem cell research builds on the Mayo Clinic’s Genesis Initiative, focusing on regenerative technologies capable of restoring or rebuilding human organs and tissues. The team is advancing to larger preclinical studies before conducting human trials.
Looking ahead, Zhu adds, “Our vision is that patients could one day receive engineered heart tissue made from their own reprogrammed cells, delivered through a minimally invasive procedure – no donor organ, no long recovery, just a repaired heart.”
A Wake-up Call for Night Shift Fatigue
Night shift fatigue is a real health and safety concern. At Children’s National Hospital in Washington, D.C., Pamela Hinds, a nursing leader and researcher, saw the effects of night shift fatigue firsthand and did something about it. Following an evidence-informed experiment, Hinds created a structured napping intervention introducing planned, controlled naps for nurses during night shifts. Learn more about what she found.