Submit to Special Issue Submit Abstract to Special Issue Review for JCM Propose a Special Issue

Journal Menu

Journal Browser

Clinical Management and Long-Term Prognosis in Intensive Care

Special Issue Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Published Papers

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

Deadline for manuscript submissions: 20 May 2026 | Viewed by 6675

Share This Special Issue

Special Issue Editors

Prof. Dr. Wioletta Mędrzycka-Dąbrowska

E-Mail Website
Guest Editor

Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
Interests: pain management; delirium; alarm management; sleep; patient and staff safety in the ICU
Special Issues, Collections and Topics in MDPI journals

Dr. Sandra Lange

E-Mail Website
Guest Editor Assistant

Department of Internal and Pediatric Nursing, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
Interests: delirium; pain management; patient and staff safety in the ICU

Special Issue Information

Dear Colleagues,

Critically ill survivors and their families are often unaware of the physical, psychological, and cognitive problems, as well as the reduced quality of life (QoL), which can persist for months or even years after discharge from the intensive care unit (ICU). Consequently, this lack of awareness leads to an underestimation of the long-term impact of critical illness on the functioning of survivors and their loved ones. This set of adverse outcomes is referred to as post-intensive care syndrome (PICS)/post-intensive care syndrome-family (PICS-F). The prevalence of chronically ill patients in critical illness is estimated to be approximately 5–20%. These patients often experience prolonged dependence on organ support, including mechanical ventilation and tracheostomy, and a prolonged length of stay (LOS) in the ICU. Although difficult to define, the concept of chronic critical illness is typically considered after 10–14 days of ICU stay.

Strategies such as early rehabilitation, implementation of the ABCDEF bundle, and promoting communication about goals and expectations for care are crucial to improving patient outcomes and helping patients return to better health, even if not fully to their pre-illness baseline. Many healthcare facilities are striving to increase patient and family participation in decision-making, pursuing shared decision-making. Although evidence is limited, shared decision-making is likely to improve patient and family outcomes and satisfaction with care. To make decision-making feasible, we invite you to share your experiences and insights on patient-relevant outcomes. This will enable the development of models for long-term outcomes for patients who survive ICU hospitalization, such as quality of life (QoL) and patient-reported outcome measures (PROMs), contributing to personalized healthcare decision-making in the ICU.

Prof. Dr. Wioletta Mędrzycka-Dąbrowska
Guest Editor

Dr. Sandra Lange
Guest Editor Assistant

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 250 words) can be sent to the Editorial Office for assessment.

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
post-intensive care syndrome
patient safety
improved survival
mental health
mechanical ventilation

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
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.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

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

Published Papers (6 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Review

20 pages, 2657 KB

Open AccessArticle

A Multicomponent Communication Intervention to Reduce the Psycho-Emotional Effects of Critical Illness in ICU Patients Related to Their Level of Consciousness: CONECTEM

by Marta Prats-Arimon, Montserrat Puig-Llobet, Mar Eseverri-Rovira, Elisabet Gallart, David Téllez-Velasco, Sara Shanchez-Balcells, Zaida Agüera, Khadija El Abidi-El Ghazouani, Teresa Lluch-Canut, Miguel Angel Hidalgo-Blanco and Mª Carmen Moreno-Arroyo

J. Clin. Med. 2026, 15(3), 1154; https://doi.org/10.3390/jcm15031154 - 2 Feb 2026

Viewed by 722

Abstract

Background/Objectives: Patients admitted to intensive care units (ICUs) are confronted with complex clinical situations that impact their physical condition and psychological well-being. Psycho-emotional disorders such as pain, anxiety and post-traumatic stress are highly prevalent in this context, significantly affecting both the patient’s experience and the quality of care provided. Effective communication can help manage patients’ psycho-emotional states and prevent post-ICU disorders. To evaluate the effectiveness of the CONECTEM communicative intervention in improving the psycho-emotional well-being of critically ill patients admitted to the intensive care unit, regarding pain, anxiety, and post-traumatic stress symptoms. Methods: A quasi-experimental study employed a pre–post-test design with both a control group and an intervention group. The study was conducted in two ICUs in a tertiary Hospital in Spain. A total of 111 critically ill patients and 180 nurse–patient interactions were included according to the inclusion/exclusion criteria. Interactions were classified according to the level of the patient’s consciousness into three groups: G1 (Glasgow 15), G2 (Glasgow 14–9), and G3 (Glasgow < 9). Depending on the patient’s communication difficulties, nurses selected one of three communication strategies of the CONECTEM intervention (AAC low teach, pictograms, magnetic board, and musicotherapy). Pain was assessed using the VAS or BPS scale, anxiety using the STAI, and symptoms of PTSD using the IES-R. The RASS scale was utilized to evaluate the degree of sedation and agitation in critically ill patients receiving mechanical ventilation. Data analysis was performed using repeated ANOVA measures for the pre–post-test, as well as Pearson’s correlation test and Mann–Whitney U or Kruskal–Wallis statistical tests. Results: The results showed pre–post differences consistent with pain after the intervention in patients with Glasgow scores of 15 (p < 0.001) and 14–9 (p < 0.001) and in anxiety (p = 0.010), reducing this symptom by 50% pre-test vs. 26.7% post-test. Patients in the intervention group with levels of consciousness (Glasgow 15–9) tended to decrease their post-traumatic stress symptoms, with reductions in the mean IES scale patients with a Glasgow score of 15 [24.7 (±15.20) vs. 22.5 (±14.11)] and for patients with a Glasgow score of 14–9 [(Glasgow 14–9) [30.2 (±13.56) 27.9 (±11.14)], though this was not significant. Given that patients with a Glasgow score below 9 were deeply sedated (RASS-4), no pre–post-test differences were observed in relation to agitation levels. Conclusions: The CONECTEM communication intervention outcomes differed between pre- and post-intervention assessments in patients with a Glasgow Coma Scale score of 15–9 regarding pain. These findings are consistent with a potential benefit of the CONECTEM communication intervention, although further studies using designs that allow for stronger causal inference are needed to assess its impact on the psycho-emotional well-being of critically ill patients. Full article

(This article belongs to the Special Issue Clinical Management and Long-Term Prognosis in Intensive Care)

► Show Figures

Figure 1

16 pages, 538 KB

Open AccessArticle

Digital Transformation in Critical Care: Implications for Quality of Care, Infection Control, and Clinical Outcomes

by Daiana Toma, Laura Andreea Ghenciu, Ovidiu Horea Bedreag, Adelina Băloi, Carmen Alina Gizea, Stelian Adrian Rițiu, Emil Robert Stoicescu, Claudiu Rafael Bârsac, Marius Păpurică, Alexandru Rogobete and Dorel Săndesc

J. Clin. Med. 2025, 14(24), 8964; https://doi.org/10.3390/jcm14248964 - 18 Dec 2025

Viewed by 1042

Abstract

Background/Objectives: Digitalization of intensive care units (ICUs) aims to enhance patient safety and efficiency through standardized documentation, real-time data integration, and clinical decision support. This study evaluated whether the implementation of a patient data management system (PDMS) was associated with improvements in quality of care, infection prevention, and patient outcomes in a trauma ICU. Methods: We conducted a single-center, retrospective, before–after cohort study comparing a pre-digitalization period (2021–2022) with a post-digitalization period (2025). Consecutive adult trauma ICU admissions were analyzed. The exposure was unit-wide adoption of a PDMS implemented in 2024. The primary outcome was ICU length of stay (LOS); secondary outcomes included ICU mortality, nosocomial infection rates (episodes per 1000 ICU-days), ventilation- and antibiotic-days, device utilization, and infection epidemiology. Prespecified sensitivity analyses were performed. Results: A total of 108 patients were included (43 pre- and 65 post-digitalization). Baseline characteristics were comparable between groups. Median ICU LOS decreased from 13.0 to 6.0 days (p = 0.02). Mortality declined from 18.6% to 6.2% (p = 0.06), and crude infection rates decreased from 42.2 to 30.8 per 1000 ICU-days (rate ratio 0.73; p = 0.28). Adjusted analyses showed no statistically significant differences for mortality (aOR 0.40; p = 0.45), infection rates (aIRR 0.88; p = 0.68), LOS (aRR 1.04; p = 0.87), ventilation-days (aRR 0.86; p = 0.65), or antibiotic-days (aRR 0.70; p = 0.30). Per-patient rates of ventilator-associated pneumonia and bloodstream infection were significantly lower after digitalization (both p = 0.04), and Acinetobacter spp. infections decreased markedly (7 to 0 cases; p = 0.001). Findings were consistent after exclusion of ICU stays < 24 h. Conclusions: ICU digitalization was associated with shorter unadjusted ICU stays and favorable trends in infection and mortality outcomes, though adjusted analyses were neutral. Larger multicenter studies incorporating device-day denominators and time-to-event analyses are needed to confirm the causal impact of digital transformation on ICU quality of care. Full article

(This article belongs to the Special Issue Clinical Management and Long-Term Prognosis in Intensive Care)

► Show Figures

Figure 1

22 pages, 761 KB

Open AccessArticle

Association Between Postoperative Pain Intensity and Delirium in Cardiac and Neurosurgical Patients: A Retrospective Pilot Study

by Mateusz Szczupak, Jacek Kobak, Jakub Wiśniewski, Jolanta Wierzchowska and Sabina Krupa-Nurcek

J. Clin. Med. 2025, 14(24), 8840; https://doi.org/10.3390/jcm14248840 - 13 Dec 2025

Cited by 1 | Viewed by 978

Abstract

Background/Objective: Postoperative pain and delirium are frequent and clinically relevant complications in patients undergoing major cardiac or neurosurgical procedures. The interaction between these conditions remains insufficiently characterized, particularly across heterogeneous surgical populations. This study aimed to investigate the relationship between postoperative pain intensity and delirium severity within the first 48 h after surgery in cardiac and neurosurgical patients. Methods: This retrospective observational analysis included 408 individuals—202 following cardiac surgery and 206 after neurosurgical procedures. Pain intensity was measured using the Numerical Rating Scale (NRS), while delirium presence and severity were assessed using the CAM-ICU and CAM-ICU-7 instruments. Associations between NRS scores, delirium severity, demographic characteristics, and ICU length of stay were examined. Results: Cardiac surgery patients experienced higher pain levels on postoperative day 1 compared with neurosurgical patients; this difference was not observed on day 2. In the cardiac cohort, higher NRS scores were positively associated with greater delirium severity on both postoperative days. No such association was detected in the neurosurgical group. Pain scores also differed across procedure types within each specialty, and several demographic variables (age, sex, ICU stay duration) were linked with variations in pain intensity. On postoperative day 1, pain intensity showed a moderate association with delirium severity (Spearman ρ = 0.23; 95% CI 0.14–0.32). Patients who developed delirium had higher pain scores (r = 0.25). In ordinal logistic regression, greater pain on postoperative day 1 independently predicted higher delirium severity (OR 2.24; 95% CI 1.70–2.94). Conclusions: Significant associations between postoperative pain intensity and delirium severity were identified in cardiac surgery patients, whereas no similar pattern emerged among neurosurgical patients. Given the retrospective design and incomplete data on perioperative pharmacotherapy, the findings should be interpreted descriptively and do not support causal conclusions. These results underscore the importance of systematic monitoring of pain and cognitive function in high-risk postoperative populations and highlight the need for prospective studies to elucidate the complex interplay between pain, perioperative factors, and postoperative delirium. Full article

(This article belongs to the Special Issue Clinical Management and Long-Term Prognosis in Intensive Care)

► Show Figures

Figure 1

20 pages, 630 KB

Open AccessArticle

The Role of C-Reactive Protein as a Biomarker for Postoperative Delirium Following Cardiac and Neurosurgical Surgery: A Retrospective Analysis

by Mateusz Szczupak, Jacek Kobak, Anna Ingielewicz, Jakub Wiśniewski and Sabina Krupa-Nurcek

J. Clin. Med. 2025, 14(22), 8252; https://doi.org/10.3390/jcm14228252 - 20 Nov 2025

Viewed by 1075

Abstract

Background/Objectives: The increasing number and complexity of cardiac and neurosurgical procedures underscore the importance of effective perioperative care. One of the most serious postoperative complications is delirium, which prolongs hospitalization, increases treatment costs, worsens rehabilitation outcomes, and increases mortality. Identifying biomarkers that predict delirium can improve patient outcomes. The aim of this study was to assess the relationship between C-reactive protein (CRP) levels and the incidence of postoperative delirium in patients after cardiac and neurosurgical procedures hospitalized in the intensive care unit. Methods: A retrospective study was conducted on 408 patients (202 undergoing cardiac surgery and 206 undergoing neurosurgery) who underwent surgery between April 2024 to the end of August 2024. Medical records were reviewed for the occurrence of delirium assessed using the Confusion Assessment Method-Intensive Care Unit scale (CAM-ICU), its severity assessed using the Confusion Assessment Method–Intensive Care Unit 7 (CAM-ICU-7), and laboratory test results, with particular emphasis on C-reactive protein levels. CRP levels were measured on postoperative days 1 and 2. Results: Postoperative delirium was noted in both groups, more frequently in patients with elevated CRP levels, indicating an active inflammatory process. In the neurosurgical group, episodes of severe delirium occurred primarily after laminectomy, whereas in the cardiac surgery group, they were most common after coronary artery bypass grafting (CABG). Conclusions: Elevated CRP levels are associated with a higher risk of postoperative delirium. Monitoring inflammatory parameters and implementing early preventive measures may improve treatment outcomes and shorten hospital stays. Further prospective studies using standardized diagnostic tools are necessary. Full article

(This article belongs to the Special Issue Clinical Management and Long-Term Prognosis in Intensive Care)

► Show Figures

Figure 1

14 pages, 889 KB

Open AccessArticle

Association Between the Blood Urea Nitrogen-to-Creatinine Ratio Trajectories and Clinical Outcomes in Critically Ill Hemorrhagic Stroke Patients: Insights from MIMIC-IV Database

by Xinyuejia Huang, Huixuan Luo, Hao Deng, Yang Wu, Mengqi Wang, Linglong Xiao, Xiaoman Shi, Wei Pan, Yuan Gao and Wei Wang

J. Clin. Med. 2025, 14(22), 8141; https://doi.org/10.3390/jcm14228141 - 17 Nov 2025

Cited by 1 | Viewed by 1268

Abstract

Background: Hemorrhagic stroke (HS) accounts for approximately 30% of all stroke cases and has high mortality in the intensive care unit (ICU). The blood urea nitrogen-to-creatinine ratio (BUNCR) is a potential biomarker of catabolic stress in critically ill patients. Meanwhile, its dynamic prognostic value in ICU-admitted HS patients remains unclear. This study utilized Group-based Trajectory Modeling (GBTM) to investigate associations between early BUNCR patterns and mortality. Methods: This study was conducted using data from the MIMIC-IV (v2.2) database. HS cases were identified via ICD-9/10. BUNCR trajectories were assessed by applying GBTM during the first 7 days. Outcomes were all-cause mortality (ACM) on day 28, on day 90, and at 1 year, with ICU and in-hospital mortality also evaluated. Kaplan–Meier survival curves and log-rank test compared survival across groups. Multivariable Cox proportional models adjusted for confounders and subgroup analysis assessed robustness. Results: Among 2559 patients (52.48% male), mortality was 10.16% (ICU), 14.07% (in-hospital), 17.00% (28-day), 22.43% (90-day), and 36.97% (1-year). Three BUNCR trajectories were identified: Group 1 (upward–downward, n = 655), Group 2 (stable upward, n = 1270), and Group 3 (downward–upward, n = 634). Group 2 had the highest ACM risk at 28-day, 90-day, and 1-year (p < 0.01), and was identified as a significant risk factor in multivariate Cox regression. Subgroup revealed significant interactions of BUNCR trajectories with age and sepsis. Conclusions: Distinct BUNCR trajectories were significantly associated with ACM in critically ill HS patients. Persistently increasing BUNCR predicted the poorest outcomes, underscoring its potential as a dynamic biomarker for timely risk stratification and informed ICU decisions. Full article

(This article belongs to the Special Issue Clinical Management and Long-Term Prognosis in Intensive Care)

► Show Figures

Figure 1

Review

Jump to: Research

17 pages, 546 KB

Open AccessReview

The Influence of Pharmacological Agents Used During General Anesthesia on the Intensity of Postoperative Pain and the Occurrence of Post-Anesthetic Delirium—A Scoping Review

by Amelia Dąbrowska, Izabella Jadwiga Brykczyńska, Sandra Lange, Mateusz Szczupak, Sabina Krupa-Nurcek and Wioletta Mędrzycka-Dąbrowska

J. Clin. Med. 2026, 15(5), 1867; https://doi.org/10.3390/jcm15051867 - 28 Feb 2026

Viewed by 1038

Abstract

Introduction: Postoperative delirium, including emergence agitation, is recognized in the post-anesthesia care unit as a fluctuating disturbance of attention and cognition. The current evidence examined suggests that both anesthetic agents and postoperative pain intensity may influence the risk of delirium. The aim of this review is to discuss the significance of pharmacological agents used during anesthesia and the relationship between the intensity of postoperative pain and the occurrence of postoperative delirium in patients undergoing surgical procedures, regardless of age. Methods: A scoping review was conducted from December 2024 to December 2025. The articles identified in each search were limited to those published between 2015 and 2025. Results: Agents such as dexmedetomidine, remimazolam, and magnesium sulfate were examined in the included trials and were reported to be associated with reducing the incidence and severity of postoperative delirium, particularly in pediatric and elderly patients. Analysis of clinical trial outcomes conducted in pediatric populations undergoing various surgical procedures suggests that dexmedetomidine (administered intranasally and intravenously) and alfentanil were associated with lower incidence and severity of emergence delirium compared to standard care or other agents (e.g., midazolam). Higher doses of dexmedetomidine (2 µg/kg) were reported to be associated with improved postoperative analgesia and reduced agitation, without prolonging recovery time or causing serious adverse effects. Propofol, due to its rapid metabolism, was suggested to contribute to shorter emergence times; however, its impact on cognitive function requires further investigation. Additionally, there remains a lack of agreed-upon and/or validated tools and strategies for pain assessment in patients experiencing delirium. Conclusions: The current evidence examined suggests that the use of intranasal dexmedetomidine at appropriate doses may be associated with reduced postoperative pain and agitation without prolonging recovery time or increasing the risk of serious adverse events. Hydromorphone was reported in the included trials to be associated with better postoperative pain control than sufentanil, whereas remimazolam, although associated with reduced delirium incidence in some trials, did not influence the length of stay in the post-anesthesia care unit. Magnesium sulfate, although not significantly affecting the incidence of delirium, was associated with alleviation of postoperative symptoms such as pain and insomnia in adult patients. Ketamine, while commonly used for analgesic therapy, did not demonstrate a consistent association with delirium prevention and, in some studies, was associated with increased neuropsychiatric events. Further research is required to more precisely define optimal perioperative delirium prevention protocols. Full article

(This article belongs to the Special Issue Clinical Management and Long-Term Prognosis in Intensive Care)

► Show Figures

Journal Menu

Journal Browser

Clinical Management and Long-Term Prognosis in Intensive Care

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (6 papers)

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI