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Key Advances in the Treatment of the Critically Ill: 3rd Edition

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

Deadline for manuscript submissions: 15 December 2025 | Viewed by 492

Special Issue Editor


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Guest Editor
First Department of Intensive Care Medicine, National and Kapodistrian University of Athens, Evaggelismos General Hospital, 10675 Athens, Greece
Interests: cardiac arrest; postcardiac arrest syndrome; mechanical ventilation; ethics of end-of-life decisions; hospital-acquired infections; airway management
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Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to the Special Issue entitled “Key Advances in the Treatment of the Critically Ill: 3rd Edition”. This is a new volume; for more details about the former two volumes, please visit the following links:
https://www.mdpi.com/journal/jcm/special_issues/critical_ill
https://www.mdpi.com/journal/jcm/special_issues/WC1XDY26S3

Intensive Care Medicine (ICM) fundamentally concerns the management of organ system failures arising from a wide array of acute and severe conditions, often compounded by coexisting comorbidities.  Survival outcomes without severe disability vary dramatically—from less than 10% to more than 90%. Over several decades of rigorous randomized controlled trials, only a handful of key therapeutic interventions have been shown to directly and significantly improve patient outcomes. Landmark interventions include lung-protective mechanical ventilation and prone positioning in acute respiratory distress syndrome (ARDS); targeted temperature management, amiodarone, and the combination of vasopressin–steroids–epinephrine, in addition to extracorporeal cardiopulmonary resuscitation (ECPR) in selected cases of cardiac arrest; tranexamic acid in trauma (including head injury); and the prompt administration of antibiotics in sepsis and septic shock.  Moreover, the systematic application of physiologically and pharmacologically sound intervention bundles—such as those outlined in current guidelines for sepsis, ARDS, and postcardiac arrest care—has played a pivotal role in enhancing patient outcomes over recent decades.

In recent years, the field has rapidly evolved through the development and application of novel therapeutic modalities.  Advanced interventions—including immunomodulatory therapies, receptor-targeting proteins, adsorbent-based blood purification technologies, and increasingly sophisticated organ support systems—are redefining clinical practice in ICM. For example, extracorporeal membrane oxygenation (ECMO) has emerged as a promising option for select patients with refractory respiratory or circulatory failure, reflecting a broader trend toward personalized, technology-driven critical care.  These innovations not only broaden the therapeutic arsenal but also hold the potential to substantially alter traditional treatment paradigms.

The present Special Issue invites submissions of reviews and original articles addressing any of the aforementioned topics related to ICM.

Prof. Dr. Spyros D. Mentzelopoulos
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

  • respiration
  • artificial ventilation
  • prone positioning
  • respiratory distress syndrome
  • respiratory insufficiency
  • cardiac arrest
  • induced hypothermia
  • amiodarone
  • vasopressin
  • steroids
  • epinephrine
  • trauma
  • injuries
  • tranexamic acid
  • sepsis
  • antibiotics
  • extracorporeal membrane oxygenation
  • extracorporeal CPR
  • blood purification

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Published Papers (1 paper)

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Research

20 pages, 869 KiB  
Article
Clinical Impact of New Delhi Metallo-Beta-Lactamase-Producing Enterobacterales in Critically Ill Patients: Are We Ready to Face the Challenge?
by Giorgia Montrucchio, Silvia Corcione, Lara Rodigari, Denisa Barganou, Chiara Risso, Riccardo Traversi, Gabriele Sales, Marco Ellena, Andrea Costamagna, Nour Shbaklo, Cecilia Grosso, Carlo Silvestre, Anna Chiara Trompeo, Vito Fanelli, Antonio Curtoni, Cristina Costa, Francesco Giuseppe De Rosa and Luca Brazzi
J. Clin. Med. 2025, 14(16), 5688; https://doi.org/10.3390/jcm14165688 - 12 Aug 2025
Viewed by 249
Abstract
Background: Carbapenem-resistant Enterobacterales infections are frequent in critically ill patients. Outbreaks caused by carbapenemase-producing Enterobacterales, in particular the New Delhi Metallo-beta-lactamase (NDM)-type carbapenemase-producing phenotype, are increasing in Italy. Unfortunately, the clinical impact of this new microorganism is still being defined, as well [...] Read more.
Background: Carbapenem-resistant Enterobacterales infections are frequent in critically ill patients. Outbreaks caused by carbapenemase-producing Enterobacterales, in particular the New Delhi Metallo-beta-lactamase (NDM)-type carbapenemase-producing phenotype, are increasing in Italy. Unfortunately, the clinical impact of this new microorganism is still being defined, as well as the correlation between colonization and invasive infections. The aim of the study is to analyze factors related to the development of NDM infections in colonized patients and to evaluate their impact on patients’ outcome in high-complexity ICUs. Methods: All patients admitted to the General and Cardiac ICUs of ‘Città della Salute e della Scienza’ University Hospital in Turin (Italy) between January and August 2023 were enrolled. Microorganisms were examined by lateral flow immunochromatographic assays or molecular assays on weekly surveillance or clinically requested cultures. Antimicrobial susceptibility was determined by broth microdilution methods and interpreted according to EUCAST breakpoints. Results: Out of a total of 915 patients, 46 (5%) were positive for NDM-producing Enterobacterales and, among them, 13 (28%) developed an invasive infection. All patients were critical (SAPS II 40+/−13). The median times between ICU admission and colonization or infection were 6 and 16 days, respectively. Significant disparities emerged between colonized and infected patients regarding days of mechanical ventilation (1 vs. 28), ICU (7 vs. 39 days), and in-hospital (21 vs. 71 days) length of stay. Renal replacement treatment (OR 8.2461, p = 0.0173, 95% CI [1.3636–65.9114]) and surgery (OR 22.8747, p = 0.0149, CI95% [1.5986–1447.743]) seemed to impact the risk of developing infection. Six patients with invasive infection were treated with Cefiderocol and five with Ceftazidime/Avibactam and Aztreonam. In absence of early identification and appropriate treatment, patients may be at increased risk of colonization spread and potentially worse clinical outcomes. Conclusions: Early identification of the carbapenemase type is clinically relevant in critically ill patients with confirmed or suspected infection, as NDM production necessitates the use of specific agents for effective treatment. Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 3rd Edition)
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