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Acute Respiratory Failure: Innovations and Clinical Insights
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Acute Respiratory Failure: Innovations and Clinical Insights

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

Deadline for manuscript submissions: 31 July 2025 | Viewed by 8105

Special Issue Editor

Prof. Dr. Gilda Cinnella

E-Mail Website
Guest Editor
Department of Anesthesia and Intensive Care, University of Foggia, 71122 Foggia, Italy
Interests: intensive care medicine; anesthesiology; cardiopulmonary resuscitation; critical care medicine; patient blood management; perioperative medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Acute respiratory failure (ARF) patients represent the widest cluster of those critically ill in ICU. Current recommended MV strategies include the use of a tidal volume of 4–6 mL/kg of predicted body weight (PBW) and a plateau pressure (Pplat) below 27 cmH2O, with a driving pressure (Pdrive) below 15 cmH2O, to mitigate the risk of ventilator-induced lung injury (VILI), reduce the onset of patient self-inflicted lung injury (P-SILI), and improve outcomes. To date, Pdrive, transpulmonary pressure, and mechanical power have been proposed as markers to quantify the risk of VILI and optimize ventilator settings, whereas no strategies for individualizing positive-end expiratory pressure (PEEP) have proven superior for improving survival. Several rescue therapies, including neuromuscular blockade, prone positioning, recruitment maneuvers (RMs), vasodilators, and extracorporeal membrane oxygenation (ECMO), may be considered to treat severe ARF. New ventilator strategies such as airway pressure release ventilation (APRV) and time-controlled adaptive ventilation (TCAV) have demonstrated potential benefits to reduce VILI. Non-invasive ventilation (NIV) and high-flow nasal oxygen (HFNO) have become further cornerstones of ARF treatment, mainly after the COVID-19 pandemic, as they help to avoid the risks related to intubation and prolonged mechanical ventilation. Future perspectives and current clinical changes are focused especially on less-invasive monitoring, such as electrical impedance tomography (EIT) and lung and diaphragm ultrasound, in order to have an easier and faster approach to treatment and no delay in the escalation of therapies. The final aim remains avoiding ARF progression and promoting a better survival after ICU recovery.

Prof. Dr. Gilda Cinnella
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

  • ARF
  • mechanical ventilation
  • VILI
  • PSILI
  • NIV
  • HFNO
  • weaning
  • EIT
  • lung US

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Published Papers (3 papers)

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Research

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15 pages, 469 KiB  
Article
Early Driving Pressure Is Associated with Major Adverse Kidney Events at 30 Days in ARDS Patients with SARS-CoV-2
by Gustavo Casas-Aparicio, Adrián E. Caballero-Islas, Antonio León-Ortiz, David Escamilla-Illescas, Yovanna Rueda-Escobedo, Carlos Ascención-López, Diana Hernández-Quino, Aimee Flores-Vargas, Jesús Sosa-Chombo, Abraham Tolentino-de La Mora, Ana Saucedo-Pruneda and Elvira Piten-Isidro
J. Clin. Med. 2025, 14(8), 2783; https://doi.org/10.3390/jcm14082783 - 17 Apr 2025
Viewed by 389
Abstract
Background: Major adverse kidney events (MAKEs), including death, persistent AKI (pAKI), and renal replacement therapy, are more common in SARS-CoV-2-related ARDS. Invasive mechanical ventilation (IMV), systemic inflammation, and hemodynamic changes drive this risk. This study examines early IMV settings and urinary kidney biomarkers [...] Read more.
Background: Major adverse kidney events (MAKEs), including death, persistent AKI (pAKI), and renal replacement therapy, are more common in SARS-CoV-2-related ARDS. Invasive mechanical ventilation (IMV), systemic inflammation, and hemodynamic changes drive this risk. This study examines early IMV settings and urinary kidney biomarkers (UKBs) to better understand the development of MAKEs at 30 days. Methods: This prospective, cross-sectional cohort study was conducted in a single center between September and October 2021. This study included adults (≥18 years) diagnosed with ARDS due to SARS-CoV-2, requiring IMV within the first 6 h of admission. Exclusion criteria included a history of chronic kidney disease (CKD) and pregnant women. Initial mechanical ventilator settings were recorded after compliance-guided PEEP titration, and urine samples were collected for the analysis of UKBs at the same time. Our primary and secondary endpoints were to assess risk factors associated with MAKEs at 30 days and pAKI, respectively. Results: The cohort included 45 patients, with a median age of 57.75 (±18.64) years. In total, 32 (71%) developed MAKEs and 22 (48.8%) developed pAKI. MAKEs were associated with older age (adjusted odds ratio (aORs) = 1.23 95% CI: 1.00–1.22; p = 0.038) and higher driving pressure (ΔP) (aORs = 1.62, 95% CI:1.01–2.60, p = 0.043). Only urinary neutrophil gelatinase-associated lipocalin (uNGal) > 40 ng/mL was associated with pAKI (aORs = 8.54, 95% CI:1.75–41.65, p = 0.008). Conclusions: Early ventilator settings, particularly higher ΔP, play a critical role in the development of MAKEs. uN-Gal could enhance the early detection of pAKI, providing opportunities for timely interventions. Full article
(This article belongs to the Special Issue Acute Respiratory Failure: Innovations and Clinical Insights)
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Review

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19 pages, 1868 KiB  
Review
Patient-Self Inflicted Lung Injury (P-SILI): An Insight into the Pathophysiology of Lung Injury and Management
by Himanshu Deshwal, Ahmed Elkhapery, Rudra Ramanathan, Deepak Nair, Isha Singh, Ankur Sinha, Rishik Vashisht and Vikramjit Mukherjee
J. Clin. Med. 2025, 14(5), 1632; https://doi.org/10.3390/jcm14051632 - 27 Feb 2025
Viewed by 2807
Abstract
Acute respiratory distress syndrome (ARDS) is a heterogeneous group of disease entities that are associated with acute hypoxic respiratory failure and significant morbidity and mortality. With a better understanding and phenotyping of lung injury, novel pathophysiologic mechanisms demonstrate the impact of a patient’s [...] Read more.
Acute respiratory distress syndrome (ARDS) is a heterogeneous group of disease entities that are associated with acute hypoxic respiratory failure and significant morbidity and mortality. With a better understanding and phenotyping of lung injury, novel pathophysiologic mechanisms demonstrate the impact of a patient’s excessive spontaneous breathing effort on perpetuating lung injury. Patient self-inflicted lung injury (P-SILI) is a recently identified phenomenon that delves into the impact of spontaneous breathing on respiratory mechanics in patients with lung injury. While the studies are hypothesis-generating and have been demonstrated in animal and human studies, further clinical trials are needed to identify its impact on ARDS management. The purpose of this review article is to highlight the physiologic mechanisms of P-SILI, novel tools and methods to detect P-SILI, and to review the current literature on non-invasive and invasive respiratory management in patients with ARDS. Full article
(This article belongs to the Special Issue Acute Respiratory Failure: Innovations and Clinical Insights)
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17 pages, 3371 KiB  
Review
Optimizing Mechanical Ventilation: A Clinical and Practical Bedside Method for the Identification and Management of Patient–Ventilator Asynchronies in Critical Care
by Vasco Costa, José Pedro Cidade, Inês Medeiros and Pedro Póvoa
J. Clin. Med. 2025, 14(1), 214; https://doi.org/10.3390/jcm14010214 - 2 Jan 2025
Viewed by 4615
Abstract
The prompt identification and correction of patient–ventilator asynchronies (PVA) remain a cornerstone for ensuring the quality of respiratory failure treatment and the prevention of further injury to critically ill patients. These disruptions, whether due to over- or under-assistance, have a profound clinical impact [...] Read more.
The prompt identification and correction of patient–ventilator asynchronies (PVA) remain a cornerstone for ensuring the quality of respiratory failure treatment and the prevention of further injury to critically ill patients. These disruptions, whether due to over- or under-assistance, have a profound clinical impact not only on the respiratory mechanics and the mortality associated with mechanical ventilation but also on the patient’s cardiac output and hemodynamic profile. Strong evidence has demonstrated that these frequently occurring and often underdiagnosed events have significant prognostic value for mechanical ventilation outcomes and are strongly associated with prolonged ICU stays and hospital mortality. Halting the consequences of PVA relies on the correct identification and approach of its underlying causes. However, this often requires advanced knowledge of respiratory physiology and the evaluation of complex ventilator waveforms in patient–ventilator interactions, posing a challenge to intensive care practitioners, in particular, those less experienced. This review aims to outline the most frequent types of PVA and propose a clinical algorithm to provide physicians with a structured approach to assess, accurately diagnose, and correct PVA. Full article
(This article belongs to the Special Issue Acute Respiratory Failure: Innovations and Clinical Insights)
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