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Clinical Management and Long-Term Prognosis in Intensive Care

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 1385

Special Issue Editors


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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
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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

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Keywords

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

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Published Papers (3 papers)

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Research

21 pages, 761 KB  
Article
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
Viewed by 241
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 [...] Read more.
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)
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20 pages, 630 KB  
Article
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 425
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 [...] Read more.
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)
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14 pages, 889 KB  
Article
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
Viewed by 532
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 [...] Read more.
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)
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