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Cardiac Anesthesia and Intensive Care
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Cardiac Anesthesia and 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: closed (15 April 2025) | Viewed by 3954

Special Issue Editor

Dr. Luigi La Via

E-Mail Website
Guest Editor
Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy
Interests: loco-regional anesthesia; pain medicine; ERAS
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue, “Cardiac Anesthesia and Intensive Care”, for the Journal of Clinical Medicine aims to showcase the latest research and advancements in the field of perioperative care for cardiac surgery patients. This Special Issue will cover a wide range of topics, including anesthetic techniques, monitoring strategies, hemodynamic management, and postoperative intensive care. The articles in this Special Issue will address the unique challenges faced by anesthesiologists and intensivists in managing patients undergoing cardiac surgery. From preoperative risk assessment to intraoperative management and postoperative care, the authors will present evidence-based approaches to optimize patient outcomes. This Special Issue will also explore the use of novel technologies, such as point-of-care ultrasound and advanced hemodynamic monitoring, in guiding clinical decision-making. Furthermore, this Special Issue will delve into the management of specific patient populations, such as those with advanced heart failure, pulmonary hypertension, or congenital heart disease. The authors will discuss the importance of multidisciplinary collaboration and the role of specialized cardiac anesthesia and intensive care teams in improving patient care. Overall, this Special Issue aims at providing a comprehensive overview of the current state of cardiac anesthesia and intensive care, highlighting the latest research findings and clinical practices. It serves as a valuable resource for anesthesiologists, intensivists, and other healthcare professionals involved in the care of cardiac surgery patients.

Dr. Luigi La Via
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

  • cardiac anesthesia
  • cardiac surgery
  • intensive care
  • perioperative management
  • hemodynamic monitoring
  • point-of-care ultrasound
  • multidisciplinary collaboration
  • patient outcomes

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Published Papers (4 papers)

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Research

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13 pages, 1303 KiB  
Article
Predictors of Prolonged Intensive Care Unit Stay and In-Hospital Mortality Following Cardiac Surgery: An Integrated Analysis from the PROCARD-ATI Study
by Călin-Dinu Hădăreanu, Diana-Ruxandra Hădăreanu, Flavia-Mihaela Stoiculescu, Mihaela-Corina Berceanu, Ionuț Donoiu, Octavian Istrătoaie, Cristina Florescu, Marius-Bogdan Novac and Victor-Cornel Raicea
J. Clin. Med. 2025, 14(8), 2747; https://doi.org/10.3390/jcm14082747 - 16 Apr 2025
Viewed by 318
Abstract
Background: Despite advances in surgical techniques and perioperative management, reliable intraoperative predictors of adverse postoperative outcomes in cardiac surgery remain elusive. This study aimed to identify perioperative factors associated with prolonged intensive care unit (ICU) stay and in-hospital mortality while defining actionable thresholds. [...] Read more.
Background: Despite advances in surgical techniques and perioperative management, reliable intraoperative predictors of adverse postoperative outcomes in cardiac surgery remain elusive. This study aimed to identify perioperative factors associated with prolonged intensive care unit (ICU) stay and in-hospital mortality while defining actionable thresholds. Methods: A retrospective analysis was conducted on 130 adult cardiac surgery patients (with a median age of 61 years, 66.2% men) from October 2022 to November 2024. Data on preoperative risk factors, intraoperative variables (cardiopulmonary bypass time-CPBT, aortic cross-clamp time-AXCT), and postoperative outcomes (ICU length of stay, in-hospital mortality) were extracted from electronic medical records. Results: Prolonged ICU stay (≥7 days) occurred in 38.5% of patients, and in-hospital mortality was 10%. AXCT was the sole independent predictor of prolonged ICU stay (OR = 1.046, 95% CI = 1.014–1.080, p = 0.005), with a 110-min cut-off (sensitivity 71%, specificity 61%, AUC = 0.729). A Kaplan–Meier analysis showed significantly longer ICU stays above this threshold (p = 0.006). For in-hospital mortality, prolonged CPBT (OR = 1.030, 95% CI = 1.003–1.057, p = 0.030), emergency surgery (OR = 0.043, 95% CI = 0.002–0.863, p = 0.040), and higher AXCT (OR = 0.965, 95% CI = 0.934–0.997, p = 0.034) were the independent predictors. A receiver operating characteristic analysis identified 140 min for AXCT (sensitivity 67%, specificity 70%, AUC = 0.707) and 227 min for CPBT (sensitivity 83%, specificity 69%, AUC = 0.824) as the optimal cut-offs. A combined model (emergency surgery yes/no, AXCT > 140 min, CPBT > 227 min) yielded excellent discrimination (AUC = 0.846). Conclusions: These findings suggest perioperative benchmarks that may guide surgical teams in refining operative strategies, reducing ICU resource utilization, and improving survival following cardiac surgery. Full article
(This article belongs to the Special Issue Cardiac Anesthesia and Intensive Care)
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16 pages, 1026 KiB  
Article
Natriuretic Peptides as a Predictor for Delirium After Cardiac Surgery: A Prospective Observational Study
by Cyril Huisinga, Eric Struck, Lorenz Mihatsch, Jens Heyn, Christian Hagl, Bernhard Zwissler, Vera von Dossow and Thomas Saller
J. Clin. Med. 2025, 14(5), 1533; https://doi.org/10.3390/jcm14051533 - 25 Feb 2025
Viewed by 466
Abstract
Background/Objectives: Subsequent to surgical procedures under cardiopulmonary bypass, at least one third of the patients experience delirium. Among others, the disruption of the blood–brain barrier results from the release of natriuretic peptides during surgery. Furthermore, natriuretic peptides increase the effect of dopamine [...] Read more.
Background/Objectives: Subsequent to surgical procedures under cardiopulmonary bypass, at least one third of the patients experience delirium. Among others, the disruption of the blood–brain barrier results from the release of natriuretic peptides during surgery. Furthermore, natriuretic peptides increase the effect of dopamine agonists, which is a key element in the pathomechanism of delirium. The primary endpoint of this study was the adjusted mean difference in natriuretic peptide concentration before surgery between patients with and without delirium. The secondary endpoints were the differences in cognitive performance and quality of life, and physical performance. Methods: Single center observational study. Setting in the Cardiac surgery and intensive care at a German tertiary medical center. Eighty patients for elective cardiac surgery under cardiopulmonary bypass for valve replacement or coronary artery bypass grafting. Preoperative NT-pro C-type natriuretic peptide (CNP) was determined. After surgery, delirium was assessed five times daily using the confusion assessment method for intensive care until 72 h after surgery and before hospital discharge. Data on quality of life and physical performance were also collected. Results: Overall, 28/80 (35%) patients developed delirium. Patients with delirium showed an increased concentration of NT-proCNP preoperatively (p = 0.016) compared to those who did not experience delirium. Patients with delirium during hospitalization reported deterioration in their physical role function (p = 0.036), vitality (p = 0.004), and social function (p = 0.008) before surgery. Conclusions: Increased NT-proCNP before surgery is associated with the occurrence of delirium. A relevant reduction in cognitive and physical performance and quality of life may be a new risk factor for delirium. Full article
(This article belongs to the Special Issue Cardiac Anesthesia and Intensive Care)
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11 pages, 2212 KiB  
Article
Clinical Characteristics of Fever After Extracorporeal Membrane Oxygenation Decannulation: Differentiating Infectious from Non-Infectious Causes of Fever and Their Impact on Outcomes
by Sua Kim, Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, YuJin Kim, Jinwook Hwang, Jae Seung Shin and Je Hyeong Kim
J. Clin. Med. 2025, 14(1), 59; https://doi.org/10.3390/jcm14010059 - 26 Dec 2024
Viewed by 809
Abstract
Background: A fever is an important sign that affects patient outcomes with various etiologies in the post-decannulation period of extracorporeal membrane oxygenation (ECMO); however, the cause is not fully understood. This study aimed to investigate the characteristics and clinical implications of fevers after [...] Read more.
Background: A fever is an important sign that affects patient outcomes with various etiologies in the post-decannulation period of extracorporeal membrane oxygenation (ECMO); however, the cause is not fully understood. This study aimed to investigate the characteristics and clinical implications of fevers after ECMO decannulation in critically ill patients. Methods: We conducted a retrospective, single-center study of adult patients who were successfully weaned off venoarterial (VA) or venovenous (VV) ECMO. Decannulation fever was defined as fever that occurred within 72 h of ECMO decannulation. The peak and duration of fever were followed for 2 weeks after decannulation, and the relationship with infection was assessed. Results: A total of 47 patients were included (22 [46.8%] on VA ECMO and 25 [53.2%] on VV ECMO). There were 35 (74.5%) patients who had decannulation fever, including 16 (34%) with active infections. Active infection during the study period was not related to the ECMO setting or duration; rather, infectious fever lasted longer than non-infectious fever (4 [interquartile range; IQR: 1–7] vs. 11 [IQR: 2–7] days, p = 0.023), and the C-reactive protein level was higher on post-decannulation day 7 (p = 0.006). Active infection was associated with increased mortality (odds ratio [OR] 6.067, 95% confidence interval [CI] 1.1289–32.644, p = 0.036), whereas decannulation fever was not (OR 0.156, 95% CI 0.025–0.977, p = 0.047). Conclusions: Fever is an important indicator of ECMO decannulation. However, the different timing and duration of fevers during the post-decannulation period of ECMO may have various clinical implications. Full article
(This article belongs to the Special Issue Cardiac Anesthesia and Intensive Care)
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Review

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12 pages, 512 KiB  
Review
Fenoldopam for Renal Protection in Cardiac Surgery: Pharmacology, Clinical Applications, and Evolving Perspectives
by Giuseppe Cuttone, Luigi La Via, Giovanni Misseri, Giulio Geraci, Massimiliano Sorbello and Federico Pappalardo
J. Clin. Med. 2024, 13(19), 5863; https://doi.org/10.3390/jcm13195863 - 1 Oct 2024
Viewed by 1935
Abstract
This comprehensive review examines the role of Fenoldopam, a selective dopamine-1 receptor agonist, in preventing and treating acute kidney injury (AKI) during cardiac surgery. AKI remains a significant complication in cardiac surgery, associated with increased morbidity, mortality, and healthcare costs. The review explores [...] Read more.
This comprehensive review examines the role of Fenoldopam, a selective dopamine-1 receptor agonist, in preventing and treating acute kidney injury (AKI) during cardiac surgery. AKI remains a significant complication in cardiac surgery, associated with increased morbidity, mortality, and healthcare costs. The review explores Fenoldopam’s pharmacological properties, mechanism of action, and clinical applications, synthesizing evidence from randomized controlled trials, meta-analyses, and observational studies. While some studies have shown promising results in improving renal function and reducing AKI incidence, others have failed to demonstrate significant benefits. The review discusses these conflicting findings, explores potential reasons for discrepancies, and identifies areas requiring further research. It also compares Fenoldopam to other renoprotective strategies, including dopamine, diuretics, and N-acetylcysteine. The safety profile of Fenoldopam, including common side effects and contraindications, is addressed. Current guidelines and recommendations for Fenoldopam use in cardiac surgery are presented, along with a cost-effectiveness analysis. The review concludes by outlining future research directions and potential new applications of Fenoldopam in cardiac surgery. By providing a thorough overview of the current state of knowledge, this review aims to facilitate informed decision-making for clinicians and researchers while highlighting areas for future investigation. Full article
(This article belongs to the Special Issue Cardiac Anesthesia and Intensive Care)
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