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Applied Cardiorespiratory Physiology in Critical Care Medicine
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Applied Cardiorespiratory Physiology in Critical Care Medicine

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

Deadline for manuscript submissions: 20 September 2026 | Viewed by 15073

Special Issue Editors

Dr. Athanasios Chalkias

E-Mail Website
Guest Editor
1. Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104-5158, USA
2. Outcomes Research Consortium, Cleveland, OH 44195, USA
3. Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece
Interests: critical care medicine; circulatory dynamics; heart-lung interactions; hemodynamics; applied cardiopulmonary physiology; critical care anesthesiology
Special Issues, Collections and Topics in MDPI journals
Dr. Paraskevi Tselioti

E-Mail Website
Guest Editor Assistant
Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece
Interests: anesthesiology and critical care medicine; pain management

Special Issue Information

Dear Colleagues,

The provision of medical care to critically ill patients remains challenging despite recent technological and scientific advances. At the same time, our understanding of the cardiopulmonary system, one of the foundations of critical care, is constantly evolving, making it particularly important to account for human physiology when managing complex disease processes. Therefore, from a physiological point of view, mastering cardiorespiratory physiology and identifying the pathophysiological mechanisms and archetypes involved in critical illness allow the physician to apply individualized management options to improve the outcomes of critically ill patients.

The Journal of Clinical Medicine is pleased to introduce a Special Issue dedicated to applied cardiorespiratory physiology in critical care medicine. The aim of this Special Issue is to reinforce our use of the physiological perspectives underpinning our understanding of severe illness and response to therapy and provide an authoritative, integrated presentation of the core information that is essential for clinical decision-making and effective patient management.

We invite physicians-scientists, clinicians, and researchers to submit their work, i.e., original research studies, narrative reviews, and/or systematic reviews and meta-analyses, in all aspects of applied cardiorespiratory physiology including, but not limited to, hemodynamic and respiratory monitoring; volume conditions of the cardiovascular system; venous return; heart-lung interactions; cardiac output; ventriculo-arterial coupling; hemodynamic coherence and microcirculation; adequacy of organ perfusion; diffusion of respiratory gases and oxygen transport to tissue; shock; advanced hemodynamic support; assessment of responsiveness to fluids, vasoactive drugs/inotropes/vasodilators, and blood/blood components; elastic forces and lung volumes; respiratory system resistance; pulmonary ventilation, circulation, and perfusion; respiratory failure; high altitude and flying; high pressure and diving; and individualized, physiology-guided management.

We hope that the content of this Special Issue will offer practical bedside knowledge for clinicians, serving as an invaluable reference for key issues regularly confronted in everyday practice.

Dr. Athanasios Chalkias
Guest Editor

Dr. Paraskevi Tselioti
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

  • applied physiology
  • critical care medicine
  • cardiovascular physiology
  • respiratory physiology

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Published Papers (3 papers)

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Review

32 pages, 2234 KB  
Review
Heart–Lung Interactions in Combined Distributive Shock and ARDS: Applied Cardiopulmonary Physiology at the Bedside
by Athanasios Chalkias, Konstantina Katsifa, Stavroula Amanetopoulou, Georgios Karapiperis, Christos Tountas, Nikoleta Ntalarizou, Athanasios Prekates and Paraskevi Tselioti
J. Clin. Med. 2025, 14(21), 7844; https://doi.org/10.3390/jcm14217844 - 5 Nov 2025
Cited by 1 | Viewed by 5282
Abstract
Distributive shock and acute respiratory distress syndrome (ARDS) are syndromes of profound pathophysiological complexity, each independently associated with high morbidity and mortality. When coexistent, they create a state of synergistic cardiopulmonary failure where conventional, protocolized management approaches are often insufficient. This review synthesizes [...] Read more.
Distributive shock and acute respiratory distress syndrome (ARDS) are syndromes of profound pathophysiological complexity, each independently associated with high morbidity and mortality. When coexistent, they create a state of synergistic cardiopulmonary failure where conventional, protocolized management approaches are often insufficient. This review synthesizes current mechanistic insights into heart–lung interactions in distributive shock with ARDS, highlighting the central role of right ventricular–pulmonary arterial coupling and the dual impact of altered lung mechanics and vascular dysregulation. We examine the distinct hemodynamic implications of pulmonary versus extrapulmonary ARDS phenotypes, including their divergent effects on transpulmonary pressure, venous return, and right ventricular afterload, and emphasize the clinical relevance of mixed phenotypes. Advanced monitoring modalities—esophageal manometry, echocardiography, and, in select cases, pulmonary artery catheterization—are presented as essential tools for dynamic phenotyping and individualized titration of ventilatory and hemodynamic strategies. Building on these principles, we outline phenotype-directed approaches to ventilation, fluid and vasoactive therapy, and adjunctive interventions such as proning and extracorporeal support. Finally, we discuss knowledge gaps and future directions, underscoring the need for integrative technologies and phenotype-stratified trials to refine precision management. The nuanced integration of cardiopulmonary physiology into bedside decision-making represents a paradigm shift toward individualized, physiology-guided care for this high-risk population. Full article
(This article belongs to the Special Issue Applied Cardiorespiratory Physiology in Critical Care Medicine)
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26 pages, 1793 KB  
Review
Cardiovascular Physiology During Mechanical Circulatory Support: Implications for Management and Monitoring
by Ettore Crimi, Karuna Rajkumar, Scott Coleman, Rohesh Fernando, Bryan Marchant, Chandrika Garner, John Gaillard, Megan H. Hicks, Ryan C. Maves and Ashish K. Khanna
J. Clin. Med. 2025, 14(19), 6935; https://doi.org/10.3390/jcm14196935 - 30 Sep 2025
Viewed by 3334
Abstract
Background/Objectives: Mechanical circulatory support (MCS) is increasingly utilized for the management of acute decompensated heart failure (HF) and cardiogenic shock (CS). The primary goals of MCS are to restore systemic perfusion, reduce cardiac workload, and support end-organ function. A thorough understanding of cardiovascular [...] Read more.
Background/Objectives: Mechanical circulatory support (MCS) is increasingly utilized for the management of acute decompensated heart failure (HF) and cardiogenic shock (CS). The primary goals of MCS are to restore systemic perfusion, reduce cardiac workload, and support end-organ function. A thorough understanding of cardiovascular physiology in patients supported by MCS is essential for clinical decision-making. This review summarizes current evidence on the physiological effects of various MCS devices, key monitoring techniques, patient management, and explores the emerging role of artificial intelligence (AI) in this field. Main Text: Short-term MCS devices include intra-aortic balloon pumps (IABP), percutaneous left-sided devices such as Impella (Abiomed, Danvers, MA, USA) and TandemHeart (LivaNova, London, UK), percutaneous right-sided support devices like Protek Duo (LivaNova, London, UK) and Impella RP Flex (Abiomed, Danvers, MA, USA), and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Long-term support is mainly provided by left ventricular assist devices (LVADs), including the HeartMate 3 (Abbott Laboratories, Chicago, IL, USA). Optimal MCS application requires an understanding of device-specific cardiovascular interactions and expertise in appropriate monitoring tools to assess device performance and patient response. The choice of device, timing of initiation, and patient selection must be individualized, with careful consideration of ethical implications. The integration of AI offers significant potential to advance clinical care by improving complication prediction, enabling real-time optimization of device settings, and refining patient selection criteria. Conclusions: MCS is a rapidly evolving field that requires a comprehensive understanding of cardiovascular interactions, careful selection of monitoring strategies, and individualized clinical management. Future research should address current device limitations, clarify device-specific clinical applications, and assess the validity of AI-driven technologies. Full article
(This article belongs to the Special Issue Applied Cardiorespiratory Physiology in Critical Care Medicine)
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12 pages, 3041 KB  
Review
Beyond the Lungs: Extrapulmonary Effects of Non-Invasive and Invasive Ventilation Strategies
by Pedro Leme Silva, Davide Chiumello, Tommaso Pozzi and Patricia Rieken Macedo Rocco
J. Clin. Med. 2025, 14(4), 1242; https://doi.org/10.3390/jcm14041242 - 13 Feb 2025
Cited by 1 | Viewed by 5232
Abstract
Background/Objectives: Non-invasive respiratory support and invasive mechanical ventilation are critical interventions that can induce significant changes not only in the lungs but also in extra-pulmonary organs, which are often overlooked. Understanding the extra-pulmonary effects of non-invasive respiratory support and invasive mechanical ventilation [...] Read more.
Background/Objectives: Non-invasive respiratory support and invasive mechanical ventilation are critical interventions that can induce significant changes not only in the lungs but also in extra-pulmonary organs, which are often overlooked. Understanding the extra-pulmonary effects of non-invasive respiratory support and invasive mechanical ventilation is crucial since it can help prevent or mitigate complications and improve outcomes. This narrative review explores these consequences in detail and highlights areas that require further research. Main Text: Non-invasive respiratory support and invasive mechanical ventilation can significantly impact various extrapulmonary organs. For instance, some ventilation strategies can affect venous return from the brain, which may lead to neurological sequelae. In the heart, regardless of the chosen ventilation method, increased intrathoracic pressure (ITP) can also reduce venous return to the heart. This reduction in turn can decrease cardiac output, resulting in hypotension and diminished perfusion of vital organs. Conversely, in certain situations, both ventilation strategies may enhance cardiac function by decreasing the work of breathing and lowering oxygen consumption. In the kidneys, these ventilation methods can impair renal perfusion and function through various mechanisms, including hemodynamic changes and the release of stress hormones. Such alterations can lead to acute kidney injury or exacerbate pre-existing renal conditions. Conclusions: This review emphasizes the critical importance of understanding the extensive mechanisms by which non-invasive respiratory support and invasive mechanical ventilation affect extrapulmonary organs, including neurological, cardiovascular, and renal systems. Such knowledge is essential for optimizing patient care and improving outcomes in critical care settings. Full article
(This article belongs to the Special Issue Applied Cardiorespiratory Physiology in Critical Care Medicine)
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