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New Perspectives and Innovations in Critical Illness
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New Perspectives and Innovations in Critical Illness

A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Intensive Care".

Deadline for manuscript submissions: 15 April 2027 | Viewed by 2356

Editors

Dr. Francesco Alessandri

E-Mail Website
Guest Editor
Department of General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
Interests: mechanical ventilation; extracorporeal membrane oxygenation; extracorporeal CO2 removal (ECCO2R); trauma; ARDS; postoperative delirium; sepsis and multidrug resistance infections in ICU
Special Issues, Collections and Topics in MDPI journals
Dr. Giovanni Giordano

E-Mail Website
Guest Editor
Department of General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
Interests: critical care; intensive care medicine; anesthesiology; ECMO; extracorporeal
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Journal of Clinical Medicine is pleased to launch a Special Issue entitled “New Perspectives and Innovations in Critical Illness.” This Special Issue showcases emerging concepts, technological advances, and evolving clinical strategies that are reshaping modern intensive care. Topics of interest include (but are not limited to) the following:

  • Novel organ support platforms (e.g., ECMO, CRRT, hemoadsorption, ECCO2R) and their translational pathways;
  • Innovative mechanical ventilation and respiratory monitoring approaches;
  • Advances in hemodynamic management, shock physiology, and cardiovascular support;
  • Immunomodulatory therapies, inflammation profiling, and precision medicine in the ICU;
  • Decision-making tools, AI-assisted monitoring, human factors, and ICU organization models.

We invite original research, narrative or systematic reviews, experimental insights, and interdisciplinary contributions for improving patient outcomes and shaping the future landscape of critical care medicine.

Thank you again for your support. I look forward to continuing our collaboration and taking to the next steps for the Special Issue.

Dr. Francesco Alessandri
Dr. Giovanni Giordano
Guest Editors

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-anonymized 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

  • critical illness
  • intensive care
  • ECMO
  • hemodynamic management
  • shock physiology
  • cardiovascular support

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

Published Papers (3 papers)

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Research

26 pages, 1215 KB  
Article
Admission Liver Enzyme Elevation Grade for Risk Stratification in Critically Ill Patients: Development and Internal Validation of an Exploratory Prognostic Model
by Giovanni Giordano, Veronica Zullino, Antonella Tosi, Giacomo Monaco, Beatrice Frasacco, Paola Celli, Franco Ruberto, Pierfrancesco Tozzi, Francesco Alessandri and Francesco Pugliese
J. Clin. Med. 2026, 15(14), 5513; https://doi.org/10.3390/jcm15145513 - 14 Jul 2026
Viewed by 436
Abstract
Background: Liver enzyme abnormalities are common in critically ill patients, but the prognostic relevance of graded aminotransferase elevation and its timing remains uncertain. We evaluated whether Liver Enzyme Elevation (LEE) grade at ICU admission provides prognostic information beyond SAPS II in a [...] Read more.
Background: Liver enzyme abnormalities are common in critically ill patients, but the prognostic relevance of graded aminotransferase elevation and its timing remains uncertain. We evaluated whether Liver Enzyme Elevation (LEE) grade at ICU admission provides prognostic information beyond SAPS II in a heterogeneous ICU cohort. Methods: In this single-centre retrospective study, adult patients admitted to a mixed ICU between January 2023 and December 2024 and with ICU length of stay ≥72 h were analysed. LEE grade was assigned from AST and ALT according to predefined multiples of the local upper limit of normal, using the higher grade reached by either enzyme. The primary outcome was ICU mortality. Secondary outcomes included renal replacement therapy, ICU length of stay, and duration of invasive mechanical ventilation. A fixed logistic model including SAPS II and admission LEE grade was internally validated by bootstrap resampling. Results: Among 274 patients, ICU mortality was 27.7%. Admission LEE grade showed an adjusted association with ICU mortality (OR 1.26 per grade increase, 95% CI 1.00–1.58; p = 0.048), while SAPS II remained the dominant predictor (OR 1.04 per point, 95% CI 1.02–1.06; p < 0.001). Adding admission LEE grade to SAPS II yielded a small absolute increase in discrimination (AUC 0.737 vs. 0.703; DeLong p = 0.039). Bootstrap-corrected AUC was 0.730, with acceptable overall calibration. Admission LEE grade was also associated with RRT and longer ICU stay in exploratory secondary analyses. Conclusions: Admission LEE grade may provide modest complementary prognostic information beyond SAPS II. These findings are exploratory and require external validation before clinical implementation. Full article
(This article belongs to the Special Issue New Perspectives and Innovations in Critical Illness)
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23 pages, 1836 KB  
Article
Early Postoperative Predictors of 30-Day Mortality After Pediatric Liver Transplantation: A Trajectory-Based Analysis
by Ibrahim Bingol, Tonguc Utku Yilmaz, Ozge Umur, Guntulu Sık, Hamdi Karakayalı and Agop Citak
J. Clin. Med. 2026, 15(11), 4385; https://doi.org/10.3390/jcm15114385 - 5 Jun 2026
Viewed by 447
Abstract
Background/Objectives: Early mortality after pediatric liver transplantation remains a clinical challenge, yet few studies have specifically addressed 30-day outcomes. Conventional pretransplant scores such as the age-appropriate MELD/PELD score were not designed for post-transplant risk prediction. We aimed to evaluate whether dynamic postoperative [...] Read more.
Background/Objectives: Early mortality after pediatric liver transplantation remains a clinical challenge, yet few studies have specifically addressed 30-day outcomes. Conventional pretransplant scores such as the age-appropriate MELD/PELD score were not designed for post-transplant risk prediction. We aimed to evaluate whether dynamic postoperative biomarker trajectories and novel composite ratios can identify high-risk patients. Methods: This single-center retrospective cohort study included 140 consecutive pediatric patients (<18 years) who underwent primary liver transplantation between 2015 and 2023. Patients were classified as deceased (≤30 days, n = 11) or survivors (>30 days, n = 129). PRISM-III, PELOD-2, and age-appropriate MELD/PELD scores were evaluated. Serial laboratory parameters were collected at pretransplant and at 0, 24, and 72 h. Delta (Δ) values and composite ratios—including lactate clearance, lactate-to-albumin ratio (LAR), INR×lactate product, platelet ratio, and fibrinogen/INR—were calculated. Penalized logistic regression (Firth method) was used for multivariate analysis. Internal validation was performed using bootstrap resampling (1000 iterations) and leave-one-out cross-validation (LOO-CV). Because two of the three components of the multivariable model (ΔINR, ΔALT) were derived from 72-h values, the model is best understood as a 72-h landmark risk model rather than as an immediate post-transplant early-warning tool. Results: The 30-day mortality rate was 7.9% (11/140), with central nervous system complications as the leading cause (36.4%). PRISM-III demonstrated excellent discrimination (AUROC 0.957; cut-off ≥ 14); the age-appropriate MELD/PELD score, a pretransplant tool not designed for post-transplant prediction, showed near-chance performance (AUROC 0.513; p = 0.576). A distinctive biomarker crossover pattern was observed: non-survivors had paradoxically lower pretransplant INR, ALT, and LAR values, but trajectories diverged sharply by 24 h. The INR×lactate product achieved an AUROC of 0.981 at 72 h. LAR at 24 h achieved 0.909, and lactate clearance at 0 → 72 h achieved 0.783. Postoperative hypernatremia emerged as a strong predictor (AUROC 0.884). In multivariate analysis, PRISM-III (OR 4.00), ΔINR (OR 3.28), and ΔALT (OR 3.46) were independent predictors (apparent AUROC 0.989). Internal validation confirmed model stability: bootstrap-corrected AUROC was 0.978; LOO-CV AUROC was 0.957 (sensitivity 90.9%, specificity 96.9%). Conclusions: Dynamic postoperative factors—rather than pretransplant disease severity—appeared more strongly associated with 30-day mortality after pediatric liver transplantation in this single-center exploratory analysis. The INR×lactate product, a novel two-variable composite, showed very high apparent discrimination (AUROC 0.981) and is proposed as a hypothesis-generating candidate marker requiring prospective external validation before any clinical use. The combined PRISM-III + ΔINR + ΔALT model (best understood as a 72-h landmark risk model, since two of its three components are defined at 72 h postoperatively) demonstrated robust internal validation performance (LOO-CV AUROC 0.957); however, given the small number of events (n = 11) and the absence of external validation, the model should be regarded as exploratory. Full article
(This article belongs to the Special Issue New Perspectives and Innovations in Critical Illness)
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10 pages, 506 KB  
Article
Significance of Peripheral Perfusion Changes During Remote Ischemic Conditioning in Critically Ill Patients
by Mantas Jaras, Edvinas Chaleckas, Zivile Pranskuniene, Tomas Tamosuitis and Andrius Pranskunas
J. Clin. Med. 2026, 15(4), 1624; https://doi.org/10.3390/jcm15041624 - 20 Feb 2026
Viewed by 789
Abstract
Objectives: This study aims to evaluate whether changes in perfusion index (PI) after the first deflation of the blood pressure cuff during remote ischemic conditioning (RIC) are associated with passive leg raising (PLR)-induced changes in stroke volume. In addition, we compared PI [...] Read more.
Objectives: This study aims to evaluate whether changes in perfusion index (PI) after the first deflation of the blood pressure cuff during remote ischemic conditioning (RIC) are associated with passive leg raising (PLR)-induced changes in stroke volume. In addition, we compared PI changes after cuff deflation during RIC between critically ill patients and healthy controls. Methods: This prospective, single-center study was conducted in a mixed ICU at a tertiary teaching hospital. Patients aged >18 years admitted to the ICU, monitored using calibrated pulse contour analysis, and scheduled for a PLR test as decided by the attending physicians were included. The PI was measured after blood pressure cuff deflations during RIC (3 cycles of brachial cuff inflation to 200 mmHg for 5 min, followed by instantaneous deflation to 0 mmHg for another 5 min) in the supine position after PLR. Preload responsiveness was defined as a ≥10% increase in the stroke volume index (SVI) during PLR. Data were compared with a healthy control group. Results: Thirty-three patients were included (median age 62; 45% in shock; 55% mechanically ventilated). When comparing critically ill patients with healthy volunteers, the maximum PI change (dPImax) and the time to reach it were higher in critically ill patients after the first and second cuff deflations (p < 0.05). However, after the third deflation, the difference was no longer significant. Following the first deflation, dPImax was significantly correlated with SVI changes during PLR (r = 0.63, p < 0.001). After the cuff was first deflated, we detected a PI cutoff with a positive SVI response (≥10%) during PLR, with a sensitivity of 64% and a specificity of 94% (area under the receiver operating characteristic curve 0.752; 95% CI, 0.564–0.940; p = 0.008). Conclusions: The maximum change in perfusion index following brachial blood pressure cuff deflation after five minutes of inflation may serve as a promising noninvasive bedside indicator of preload responsiveness in critically ill patients. Additionally, the observed normalization of PI kinetics during RIC suggests possible acute modulation of vascular reactivity, though further research is needed to confirm an association between PI changes and endothelial function. Full article
(This article belongs to the Special Issue New Perspectives and Innovations in Critical Illness)
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