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Critical Care Update: Innovations in Diagnostic & Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (15 June 2022) | Viewed by 18823

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Special Issue Editors

Dr. Sasa Rajsic

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Guest Editor

Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
Interests: critical care; intensive care; ECMO; anaesthesia; emergency medicine; cardiology
Special Issues, Collections and Topics in MDPI journals

Dr. Benedikt Treml

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Guest Editor

General and Surgical Intensive Care Unit, University Clinic for Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
Interests: hypoxia; coagulation; critical care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The concept of intensive care unit has existed for almost 70 years, with outstanding development progress in recent decades. Multidisciplinary care of critically ill patients has become an integral part of every modern healthcare system, ensuring improved care and reduced mortality. Easier access to care, early recognition of severe medical and surgical illnesses, advanced prehospital care, and organized immediate care in trauma centers lead to the rise of ICU patients. Moreover, continuous research and the fast development of technologies in the field of critical care face clinicians with the need for continuous education. The main goal of this Special Issue is to summarize and collect the newest information on epidemiology, pathophysiology, diagnostics, monitoring, therapeutic strategies, and patient-related outcomes in critical care.

The present Special Issue on “Critical Care Update: Innovations in Diagnostic and Treatment” welcomes the submission of work related to the most recent developments in experimental and clinical intensive care and emergency medicine research and practice, addressing innovative therapeutic and diagnostic strategies in the care of the critically ill. We invite all researchers of associated disciplines who focus on the care of acutely ill patients to submit original articles or reviews in their area of expertise, enhancing the multidisciplinarity of modern critical care.

Dr. Sasa Rajsic
Dr. Benedikt Treml
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

intensive care
ICU
critical care
acute care
emergency medicine
multidisciplinary care
Trauma
sepsis
COVID-19
acute respiratory distress syndrome
ARDS
extracorporeal life support
ECMO
acute renal failure
mechanical ventilation
in-hospital emergencies management

Published Papers (6 papers)

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Research

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12 pages, 2018 KiB

Open AccessArticle

Correlation of Lung Damage on CT Scan with Laboratory Inflammatory Markers in COVID-19 Patients: A Single-Center Study from Romania

by Cosmin Citu, Oana Maria Gorun, Andrei Motoc, Ioana Mihaela Citu, Florin Gorun and Daniel Malita

J. Clin. Med. 2022, 11(15), 4299; https://doi.org/10.3390/jcm11154299 - 25 Jul 2022

Cited by 9 | Viewed by 1399

Abstract

(1) Background: This study aims to evaluate the association of CRP, NLR, IL-6, and Procalcitonin with lung damage observed on CT scans; (2) Methods: A cross-sectional study was performed among 106 COVID-19 patients hospitalized in Timisoara Municipal Emergency Hospital. Chest CT and laboratory analysis were performed in all patients. The rank Spearmen correlation was used to assess the association between inflammatory markers and lung involvement. In addition, ROC curve analysis was used to determine the accuracy of inflammatory markers in the diagnosis of severe lung damage; (3) Results: CRP, NLR, and IL-6 were significantly positively correlated with lung damage. All inflammatory markers had good accuracy for diagnosis of severe lung involvement. Moreover, IL-6 has the highest AUC- ROC curve; (4) Conclusions: The inflammatory markers are associated with lung damage and can be used to evaluate COVID-19 severity. Full article

(This article belongs to the Special Issue Critical Care Update: Innovations in Diagnostic & Treatment)

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16 pages, 1336 KiB

Open AccessArticle

The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding

by Sasa Rajsic, Robert Breitkopf, Ulvi Cenk Oezpeker, Zoran Bukumirić, Moritz Dobesberger and Benedikt Treml

J. Clin. Med. 2022, 11(9), 2314; https://doi.org/10.3390/jcm11092314 - 21 Apr 2022

Cited by 14 | Viewed by 2572

Abstract

Extracorporeal membrane oxygenation (ECMO) is increasingly used in carefully selected patients with cardiac or respiratory failure. However, complications are common and can be associated with worse outcomes, while data on risk factors and outcomes are inconsistent and sparse. Therefore, we sought to investigate potential risk factors and predictors of haemorrhage and adverse events during ECMO and its influence on mortality. We retrospectively reviewed all patients on ECMO support admitted to intensive care units of a tertiary university centre in Austria. In a period of ten years, ECMO support was used in 613 patients, with 321 patients meeting the inclusion criteria of this study. Haemorrhage, occurring in more than one third of the included patients (123, 38%), represented the most common and serious ECMO complication, being associated with an increased one year mortality (51% vs. 35%, p = 0.005). The main risk factors for haemorrhage were severity of the disease (hazard ratio (HR) = 1.01, p = 0.047), a prolonged activated partial thromboplastin time (HR = 1.01, p = 0.007), and lower values of C-reactive protein (HR = 0.96, p = 0.005) and procalcitonin (HR = 0.99, p = 0.029). In summary, haemorrhage remained the main ECMO complication with increased mortality. Moreover, we reported a possible association of lower inflammation and bleeding during ECMO support for the first time. This generated a new hypothesis that warrants further research. Finally, we recommend stricter monitoring of anticoagulation especially in patients without hyperinflammation. Full article

(This article belongs to the Special Issue Critical Care Update: Innovations in Diagnostic & Treatment)

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Graphical abstract

10 pages, 663 KiB

Open AccessArticle

Better Control of Body Temperature Is Not Associated with Improved Hemodynamic and Respiratory Parameters in Mechanically Ventilated Patients with Sepsis

by Andrej Markota, Kristijan Skok, Žiga Kalamar, Jure Fluher and Mario Gorenjak

J. Clin. Med. 2022, 11(5), 1211; https://doi.org/10.3390/jcm11051211 - 24 Feb 2022

Cited by 4 | Viewed by 1546

Abstract

The need for temperature modulation (mostly cooling) in critically ill patients is based on the expected benefits associated with decreased metabolic demands. However, evidence-based guidelines for temperature management in a majority of critically ill patients with fever are still lacking. The aim of our retrospective single-site observational study was to determine the differences in ICU treatment between patients in whom their temperature remained within the target temperature range for ≥25% of time (inTT group) and patients in whom their temperature was outside the target temperature range for <24% of time (outTT group). We enrolled 76 patients undergoing invasive mechanical ventilation for respiratory failure associated with sepsis. We observed no significant differences in survival, mechanical ventilation settings and duration, vasopressor support, renal replacement therapy and other parameters of treatment. Patients in the inTT group were significantly more frequently cooled with the esophageal cooling device, received a significantly lower cumulative dose of acetaminophen and significantly more frequently developed a presence of multidrug-resistant pathogens. In our study, achieving a better temperature control was not associated with any improvement in treatment parameters during ICU stay. A lower prevalence of multidrug-resistant pathogens in patients with higher body temperatures opens a question of a pro-pyrexia approach with an aim to achieve better patient outcomes. Full article

(This article belongs to the Special Issue Critical Care Update: Innovations in Diagnostic & Treatment)

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14 pages, 1337 KiB

Open AccessEditor’s ChoiceArticle

Fluid Overload Phenotypes in Critical Illness—A Machine Learning Approach

by Anna S. Messmer, Michel Moser, Patrick Zuercher, Joerg C. Schefold, Martin Müller and Carmen A. Pfortmueller

J. Clin. Med. 2022, 11(2), 336; https://doi.org/10.3390/jcm11020336 - 11 Jan 2022

Cited by 12 | Viewed by 2139

Abstract

Background: The detrimental impact of fluid overload (FO) on intensive care unit (ICU) morbidity and mortality is well known. However, research to identify subgroups of patients particularly prone to fluid overload is scarce. The aim of this cohort study was to derive “FO phenotypes” in the critically ill by using machine learning techniques. Methods: Retrospective single center study including adult intensive care patients with a length of stay of ≥3 days and sufficient data to compute FO. Data was analyzed by multivariable logistic regression, fast and frugal trees (FFT), classification decision trees (DT), and a random forest (RF) model. Results: Out of 1772 included patients, 387 (21.8%) met the FO definition. The random forest model had the highest area under the curve (AUC) (0.84, 95% CI 0.79–0.86), followed by multivariable logistic regression (0.81, 95% CI 0.77–0.86), FFT (0.75, 95% CI 0.69–0.79) and DT (0.73, 95% CI 0.68–0.78) to predict FO. The most important predictors identified in all models were lactate and bicarbonate at admission and postsurgical ICU admission. Sepsis/septic shock was identified as a risk factor in the MV and RF analysis. Conclusion: The FO phenotypes consist of patients admitted after surgery or with sepsis/septic shock with high lactate and low bicarbonate. Full article

(This article belongs to the Special Issue Critical Care Update: Innovations in Diagnostic & Treatment)

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Review

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10 pages, 438 KiB

Open AccessReview

Use of Hyperoncotic Human Albumin Solution in Severe Traumatic Brain Injury Revisited—A Narrative Review and Meta-Analysis

by Christian J. Wiedermann

J. Clin. Med. 2022, 11(9), 2662; https://doi.org/10.3390/jcm11092662 - 9 May 2022

Cited by 5 | Viewed by 5636

Abstract

A significant proportion of patients with a severe traumatic brain injury (TBI) have hypoalbuminemia and require fluid resuscitation. Intravenous fluids can have both favorable and unfavorable consequences because of the risk of hyperhydration and hypo- or hyperosmolar conditions, which may affect the outcome of a TBI. Fluid resuscitation with human albumin solution (HAS) corrects low serum albumin levels and aids in preserving euvolemia in non-brain-injured intensive care units and in perioperative patients. However, the use of HAS for TBI remains controversial. In patients with TBI, the infusion of hypooncotic (4%) HAS was associated with adverse outcomes. The side effects of 4% HAS and the safety and efficacy of hyperoncotic (20–25%) HAS used in the Lund concept of TBI treatment need further investigation. A nonsystematic review, including a meta-analysis of controlled clinical trials, was performed to evaluate hyperoncotic HAS in TBI treatment. For the meta-analysis, the MEDLINE and EMBASE Library databases, as well as journal contents and reference lists, were searched for pertinent articles up to March 2021. Four controlled clinical studies involving 320 patients were included. The first was a randomized trial. Among 165 patients treated with hyperoncotic HAS, according to the Lund concept, 24 (14.5%) died vs. 59 out of 155 control patients (38.1%). A Lund concept intervention using hyperoncotic HAS was associated with a significantly reduced mortality (p = 0.002). Evidence of the beneficial effects of fluid management with hyperoncotic HAS on mortality in patients with TBI is at a high risk of bias. Prospective randomized controlled trials are required, which could lead to changes in clinical practice recommendations for fluid management in patients with TBI. Full article

(This article belongs to the Special Issue Critical Care Update: Innovations in Diagnostic & Treatment)

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16 pages, 1833 KiB

Open AccessReview

Real-Time Monitoring of Blood Parameters in the Intensive Care Unit: State-of-the-Art and Perspectives

by Rebecca Bockholt, Shaleen Paschke, Lars Heubner, Bergoi Ibarlucea, Alexander Laupp, Željko Janićijević, Stephanie Klinghammer, Sascha Balakin, Manfred F. Maitz, Carsten Werner, Gianaurelio Cuniberti, Larysa Baraban and Peter Markus Spieth

J. Clin. Med. 2022, 11(9), 2408; https://doi.org/10.3390/jcm11092408 - 25 Apr 2022

Cited by 7 | Viewed by 4522

Abstract

The number of patients in intensive care units has increased over the past years. Critically ill patients are treated with a real time support of the instruments that offer monitoring of relevant blood parameters. These parameters include blood gases, lactate, and glucose, as well as pH and temperature. Considering the COVID-19 pandemic, continuous management of dynamic deteriorating parameters in patients is more relevant than ever before. This narrative review aims to summarize the currently available literature regarding real-time monitoring of blood parameters in intensive care. Both, invasive and non-invasive methods are described in detail and discussed in terms of general advantages and disadvantages particularly in context of their use in different medical fields but especially in critical care. The objective is to explicate both, well-known and frequently used as well as relatively unknown devices. Furtehrmore, potential future direction in research and development of realtime sensor systems are discussed. Therefore, the discussion section provides a brief description of current developments in biosensing with special emphasis on their technical implementation. In connection with these developments, the authors focus on different electrochemical approaches to invasive and non-invasive measurements in vivo. Full article

(This article belongs to the Special Issue Critical Care Update: Innovations in Diagnostic & Treatment)

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