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Recent Advances in Therapy of Trauma and Surgical Critical Care
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Recent Advances in Therapy of Trauma and Surgical Critical Care

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

Deadline for manuscript submissions: 15 May 2025 | Viewed by 5987

Special Issue Editor

Dr. Rita Galeiras

E-Mail Website
Guest Editor
Intensivist. Critical Care Unit & Burn Unit, Complexo Hospitalario Universitario A Coruña, As Xubias, 84. 15006 A Coruña, Spain
Interests: shock; burns; emergency medicine; critical care; mechanical ventilation

Special Issue Information

Dear Colleagues,

In recent years, the management of trauma and surgical critical care has seen remarkable advances, driven by innovations, technological advances, and interdisciplinary collaboration. The intervention of different specialists on the patient creates an opportunity to optimise objectives: "the right patient, to the right place, at the right time, to receive the right care". In this sense, bleeding control protocols, damage control surgery, minimally invasive techniques, and new imaging modalities have become increasingly important in reducing the risk of complications and facilitating earlier mobilisation. Similarly, new monitoring strategies provide physiological parameters that allow for more targeted interventions. This Special Issue aims at providing an update on clinical and technological aspects for professionals involved in the initial critical care of this complex group of patients.

Areas of interest in this Special Issue include, but are not limited to, the following:

  • Postoperative delirium in the ICU;
  • Burn pain: types, identification and management;
  • Cirrhosis and severe trauma;
  • Evidence for prognostic scales in critically ill trauma patients;
  • Cardiac arrest in trauma victims;
  • Blunt thoracic aortic trauma;
  • Acute management of pelvic trauma;
  • Advances and new therapies in traumatic spinal cord injury;
  • Respiratory support in blunt thoracic trauma;
  • Neuromonitoring in brain trauma;
  • Bleeding and coagulopathy in trauma;
  • Severe acute pancreatitis: Indications for surgical intervention;
  • Major abdominal trauma;
  • Damage control surgery.

We welcome high-quality original studies (clinical and experimental), well-designed meta-analyses, and informative reviews. We look forward to your contributions.

Dr. Rita Galeiras
Guest Editor

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

  • trauma management
  • trauma care
  • burn
  • critical care
  • damage control surgery
  • traumatic spinal cord injury

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  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • e-Book format: Special Issues with more than 10 articles can be published as dedicated e-books, ensuring wide and rapid dissemination.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Research

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11 pages, 2683 KiB  
Article
High-Pressure Injection Injury of the Hand—A Rare but True Surgical Emergency
by Mihaela Pertea, Stefana Luca, Malek Benamor, Mihai-Codrin Constantinescu, Andra-Irina Bulgaru-Iliescu, Alexandru Amarandei, Dan-Cristian Moraru, Khairi Saibi, Samar Ben Mrad, Alexandru Filip and Nina Filip
J. Clin. Med. 2025, 14(1), 72; https://doi.org/10.3390/jcm14010072 - 27 Dec 2024
Viewed by 1017
Abstract
Background/Objectives: The aim is to bring attention to the existence of a rare type of trauma of the hand, high-pressure injection injury, that appears to be minor with negligible signs and symptoms within the first hours after the accident, but in reality, [...] Read more.
Background/Objectives: The aim is to bring attention to the existence of a rare type of trauma of the hand, high-pressure injection injury, that appears to be minor with negligible signs and symptoms within the first hours after the accident, but in reality, produces significant tissue destruction with severe consequences. Recognizing this type of trauma by medical personnel, understanding the mechanisms involved, and knowing the etiological and prognostic factors can lead to early treatment initiation and avoid severe mutilating sequelae. Methods: A retrospective study on 16 patients diagnosed with high-pressure injection injuries, including water, air, paint, paint mixed paint with thinner, petroleum jelly, and lime (washable paint containing calcium oxide). The patients’ epidemiological data, the time from accident to diagnosis, reasons for delayed diagnosis, treatments applied, and outcomes were recorded and evaluated. Results: All injuries occurred at the workplace due to negligence. Oil-based paint was implicated in 31.25% of cases. The most frequently affected anatomical region was the volar surface of the distal phalanx of the nondominant hand index finger. In one case, delayed presentation to medical care and diagnosis resulted in a compartment syndrome, requiring amputation. Conclusions: It is crucial to recognize and understand this type of trauma, as it constitutes an emergency due to its rapid progression. Delayed diagnosis can result in massive tissue destruction, potentially leading to the loss of limb segments and debilitating functional sequelae, which may severely impact a patient’s socio-professional life. Full article
(This article belongs to the Special Issue Recent Advances in Therapy of Trauma and Surgical Critical Care)
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10 pages, 912 KiB  
Article
Comparison of Conventional versus Modified Preperitoneal Pelvic Packing in Patients with Bleeding Pelvic Fractures: A Single-Center Retrospective Pilot Study
by Sebeom Jeon, Byungchul Yu, Gil Jae Lee, Min A Lee, Jungnam Lee and Kang Kook Choi
J. Clin. Med. 2024, 13(14), 4062; https://doi.org/10.3390/jcm13144062 - 11 Jul 2024
Cited by 1 | Viewed by 1231
Abstract
Background: Bleeding pelvic fractures have high mortality rates, primarily due to severe hemorrhage. Treatment options include mechanical stabilization based on preperitoneal pelvic packing (PPP), resuscitative endovascular balloon occlusion of the aorta, and angioembolization (AE). The bilateral preperitoneal approach, which uses three pads [...] Read more.
Background: Bleeding pelvic fractures have high mortality rates, primarily due to severe hemorrhage. Treatment options include mechanical stabilization based on preperitoneal pelvic packing (PPP), resuscitative endovascular balloon occlusion of the aorta, and angioembolization (AE). The bilateral preperitoneal approach, which uses three pads on each side, is the conventional PPP method. We aimed to compare the bilateral preperitoneal approach with a modified approach, involving selectively packing only heavily bleeding areas, in terms of clinical outcomes and mortality risks. Methods: We included patients who underwent PPP and compared the outcomes between conventional (three sponges placed on each side) and modified PPP (selective packing of critical areas). The primary outcome was 30-day mortality; the secondary outcomes included 24 h mortality, pelvic complications, and transfusion requirements. Univariate and multivariate analyses were performed to determine risk factors for 30-day and 24 h mortality. Results: Among the 47 included patients, 19 and 28 underwent conventional and modified PPP, respectively. There were no significant between-group differences in the 24 h (26.3% vs. 42.9%, p = 0.247) and 30-day mortality rates (47.4% vs. 60.7%, p = 0.366). Using univariate and multivariate analyses, initial lactate levels and the decision to perform AE were found to be significant risk factors for mortality. However, the selected PPP method was not a risk factor for 30-day mortality (odds ratio [OR], 2.22; 95% confidence interval [CI], 0.27–18.26; p = 0.457) or 24 hr mortality (OR, 1.77; 95% CI, 0.24–13.19; p = 0.557). Conclusions: The modified PPP method may be considered in patients with bleeding pelvic fractures for effective bleeding control while minimizing potential complications associated with the conventional PPP. Full article
(This article belongs to the Special Issue Recent Advances in Therapy of Trauma and Surgical Critical Care)
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Review

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41 pages, 490 KiB  
Review
Advances and New Therapies in Traumatic Spinal Cord Injury
by Antonio Montoto-Marqués, Jesús Benito-Penalva, María Elena Ferreiro-Velasco, Mark Andrew Wright, Sebastian Salvador-De la Barrera, Hatice Kumru, Nelson Gaitán-Pérez, Agustin Hernández-Navarro, Antonio Rodríguez-Sotillo, Fernando Martins Braga, Angela Palencia-Vidal and Joan Vidal-Samsó
J. Clin. Med. 2025, 14(7), 2203; https://doi.org/10.3390/jcm14072203 - 24 Mar 2025
Viewed by 2018
Abstract
Recovery from traumatic spinal cord injury (tSCI) is challenging due to the limited regenerative capacity of the central nervous system to restore cells, myelin, and neural connections. At the clinical level, the fundamental pillars of treatment are the reduction in secondary damage (neuroprotection) [...] Read more.
Recovery from traumatic spinal cord injury (tSCI) is challenging due to the limited regenerative capacity of the central nervous system to restore cells, myelin, and neural connections. At the clinical level, the fundamental pillars of treatment are the reduction in secondary damage (neuroprotection) and rehabilitation; these are the tools we have to mitigate the disability caused by spinal cord injury (SCI). To date, the treatments on which neuroprotection has been based are the prevention of acute respiratory failure to avoid hypoxia, early hemodynamic control, neuroprotective drugs and surgical management. Optimizing early hemodynamic control to ensure adequate spinal cord perfusion may be key to the management of SCI. While neuroprotective agents like methylprednisolone have fallen into disuse, several promising therapies are currently being tested in clinical trials. In terms of surgical treatment, although their impact on neurological recovery remains debated, appropriate early bone decompression followed by duroplasty in selected cases is increasingly recommended. Advances in cell therapies hold significant potential for enhancing both clinical and functional outcomes in SCI patients. Moreover, emerging neuromodulation techniques, such as transcutaneous and epidural stimulation, along with innovations in rehabilitation technologies—such as robotic systems and exoskeletons—are becoming indispensable tools for improving locomotion and overall mobility in individuals with SCI. This article provides an update on the advances in neuroprotection against secondary damage caused by tSCI, in cellular therapies, and in new rehabilitation therapies. Full article
(This article belongs to the Special Issue Recent Advances in Therapy of Trauma and Surgical Critical Care)
23 pages, 769 KiB  
Review
Multifaceted Pathophysiology and Secondary Complications of Chronic Spinal Cord Injury: Focus on Pressure Injury
by Mario Martínez-Torija, Pedro F. Esteban, Angela Santos-De-La-Mata, Matilde Castillo-Hermoso, Eduardo Molina-Holgado and Rafael Moreno-Luna
J. Clin. Med. 2025, 14(5), 1556; https://doi.org/10.3390/jcm14051556 - 26 Feb 2025
Viewed by 983
Abstract
Background/Objectives: Spinal cord injury (SCI) is a complex medical condition with widespread effects that extend beyond motor and sensory impairments. In addition to nervous system damage, SCI patients experience various secondary complications, including vascular dysfunction, altered body composition, and metabolic disturbances. Among [...] Read more.
Background/Objectives: Spinal cord injury (SCI) is a complex medical condition with widespread effects that extend beyond motor and sensory impairments. In addition to nervous system damage, SCI patients experience various secondary complications, including vascular dysfunction, altered body composition, and metabolic disturbances. Among the most common secondary pathologies is the development of pressure injuries (PIs), chronic wounds that significantly affect quality of life and can be challenging to treat. Understanding the physiological and cellular mechanisms behind these complications is crucial for improving care and therapeutic outcomes. Methods: We conducted a comprehensive literature search in PubMed, Scopus, and Google Scholar using keywords related to spinal cord injury, pressure ulcer/pressure injuries, metabolic and vascular dysfunction, biomechanics, and regenerative therapies. Studies were selected based on their relevance to the pathophysiology, risk factors, and novel therapeutic approaches for PIs in SCI patients. Results: Vascular dysfunction, characterized by impaired blood flow and microcirculatory issues, predisposes SCI patients to ischemia and tissue necrosis, particularly in areas subjected to prolonged pressure. Additionally, changes in body composition, such as increased adiposity and muscle atrophy, further compromise tissue integrity and healing capacity. The inflammatory response, mediated by cytokines such as IL-1, IL-6, and TNF-α, exacerbates these effects by sustaining a pro-inflammatory environment that delays the transition of macrophages to the M2 phenotype, critical for wound healing. External factors, such as poor nutrition, infections, and immobility, also play a significant role in worsening the wound healing process. Conclusions: Chronic SCI induces a cascade of physiological changes that predispose patients to the development of PIs and complicate their recovery. The intricate interplay of vascular, metabolic, and inflammatory responses creates a hostile environment for wound healing. A deeper understanding of these systemic effects is essential not only for developing targeted therapeutic strategies to improve chronic wound healing but also for refining preventive approaches that minimize their occurrence. Advancing this knowledge will ultimately help enhance the quality of life for individuals with SCI. Full article
(This article belongs to the Special Issue Recent Advances in Therapy of Trauma and Surgical Critical Care)
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