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Key Advances in the Treatment of the Critically Ill: 2nd 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: closed (31 December 2024) | Viewed by 5789

Special Issue Editor

Prof. Dr. Spyros D. Mentzelopoulos

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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
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Intensive Care Medicine (ICM) aims to address organ-system failures in the context of an extremely broad variety of acute and severe disease states and coexisting comorbid conditions. Accordingly, survival without severe disability may vary from <10% to >90%. Despite intense randomized controlled clinical research for several decades, only a handful of key therapeutic interventions have been shown to directly improve important and/or critical patient outcomes. Examples include lung-protective mechanical ventilation and prone positioning in acute respiratory distress syndrome (ARDS), targeted temperature management, amiodarone, and the vasopressin–steroids–epinephrine combination in cardiac arrest, tranexamic acid in trauma (including head injury), and early antibiotics in sepsis/septic shock. Furthermore, the use of bundles of physiologically and pharmacologically sound interventions, such as those recommended in the context of guidelines for sepsis/septic shock, ARDS and postcardiac arrest care, may have also contributed to the observed improvements in outcomes over the past decades.

The severe acute respiratory syndrome coronavirus-2 pandemic has prompted urgent and intensified research on the development of effective treatments such as the messenger RNA-based vaccines, immunomodulating interventions and antiviral pills. Additionally, extracorporeal membrane oxygenation still constitutes a potentially promising intervention for selected patients with treatment-refractory respiratory and/or circulatory failure. Notably, the rapid evolution of evidence-based ethical guidelines and the introduction of palliative care options seem to increasingly augment the consistency between actually administered treatments and patient/family values, goals and preferences.

This Special Issue invites submissions of reviews and original articles related to 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
  • prone position
  • respiratory distress syndrome
  • respiratory insufficiency
  • heart arrest
  • hypothermia
  • induced
  • amiodarone
  • vasopressins
  • steroids
  • epinephrine
  • multiple trauma
  • wounds and injuries
  • tranexamic acid
  • sepsis
  • anti-bacterial agents
  • COVID-19
  • COVID-19 vaccines
  • COVID-19 breakthrough infections
  • COVID-19 drug treatment
  • extracorporeal membrane oxygenation

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Related Special Issues

Published Papers (6 papers)

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Research

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16 pages, 1327 KiB  
Article
The Importance of Frailty in Determining Survival After Intensive Care
by Orsolya Szűcs, László G. Élő, Gábor Élő, Réka Varga, Réka Jung, Edit Benkovics, László Szabó and László Zubek
J. Clin. Med. 2025, 14(5), 1760; https://doi.org/10.3390/jcm14051760 - 5 Mar 2025
Viewed by 675
Abstract
Background: Estimating survival and long-term quality of life after intensive care has been a crucial bioethical endeavour in recent decades to improve end-of-life decision-making. Scientific studies have also shown that patient frailty influences survival, but only a few long-term data are available. Methods: [...] Read more.
Background: Estimating survival and long-term quality of life after intensive care has been a crucial bioethical endeavour in recent decades to improve end-of-life decision-making. Scientific studies have also shown that patient frailty influences survival, but only a few long-term data are available. Methods: We conducted a prospective observational study at the Department of Anaesthesiology and Intensive Care of Semmelweis University, Hungary, to investigate the association between physical status on admission, the chance of survival, and the long-term quality of life of the patient. We recorded the pre-admission frailty score (Clinical Frailty Scale), APACHE II, and SAPS II scores on admission. The first follow-up was 3 months after discharge when the quality of life of the patient was assessed using the EQ5-D questionnaire. During the second follow-up one year later, we recorded the EQ5-D, Mini-Mental Test, and the Beck Depression Inventory scales. Results: Our study demonstrated that the ROC analysis of predicted overall mortality based on CFS score is similar in accuracy to that of predicted mortality by APACHE II and SAPS II point systems. The multivariate logistic regression calculations show that the best performing of the three independent variables is the SAPS II estimator (78.5%), but the estimators of both acute condition scoring systems (APACHE and SAPS) can be improved (79.5% vs. 84%) when taking into account the CFS value. The prevalence of mood and mental disorders among patients who survived one year was not different from that of the general population. Conclusions: The physiological scoring systems examined are all suitable for estimating the risk of overall mortality. The CFS shows similar efficacy and appears to be additive in value, with scales describing the severity of acute illness, which are indicative of the chronic condition of the patient. Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 2nd Edition)
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14 pages, 1229 KiB  
Article
Intubation Versus Tracheotomy Outcomes in Critically Ill COVID-19 Patients in Low-Resource Settings: What Do We Know?
by Pedja Kovacevic, Goran Baric, Sasa Dragic, Danica Momcicevic, Biljana Zlojutro, Milka Jandric, Tijana Kovacevic, Daniel Lovric, Ivan Palibrk and Jihad Mallat
J. Clin. Med. 2025, 14(3), 978; https://doi.org/10.3390/jcm14030978 - 3 Feb 2025
Viewed by 614
Abstract
Background: Patients undergoing prolonged mechanical ventilation commonly require tracheotomy. The main aim of this study was to evaluate the outcomes of tracheotomy for patients with acute respiratory distress syndrome (ARDS) associated with COVID-19 in low-resource settings. Methods: A retrospective, single-center, observational [...] Read more.
Background: Patients undergoing prolonged mechanical ventilation commonly require tracheotomy. The main aim of this study was to evaluate the outcomes of tracheotomy for patients with acute respiratory distress syndrome (ARDS) associated with COVID-19 in low-resource settings. Methods: A retrospective, single-center, observational cohort study was performed on patients with ARDS associated with COVID-19. Patients who underwent intubation alone were compared with those who received both intubation and subsequent tracheotomy. The analysis included patient demographics, comorbidities, and outcomes. Results: Patients undergoing tracheotomy (n = 89) were compared with intubated patients (n = 622). The median time from intubation to tracheotomy was 10 days (IQR: 6–15 days). Overall, 608 patients (85.5%) died in the hospital. Thirty-seven patients (35.9%) in the survival group had tracheostomy compared with fifty-two patients (8.5%) in the non-survival group (p < 0.001). The Kaplan–Meier curve shows a higher probability of survival in the tracheotomy group compared with the non-tracheotomy group (log-rank test: p < 0.001). Tracheotomy was found to be independently associated with lower in-hospital mortality (HR = 0.16 [95% CI: 0.11–0.23], p < 0.001) in the multivariable Cox proportional hazards regression analysis after adjusting for potential confounding factors. Furthermore, tracheotomy was associated with a higher cumulative incidence of being alive and off the ventilator at day 28 (SHR = 2.87 [95% CI: 1.88–4.38], p < 0.001). Conclusions: Tracheotomy was associated with reduced in-hospital mortality and longer ventilator-free days. Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 2nd Edition)
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13 pages, 2141 KiB  
Article
Beyond Trauma-Induced Coagulopathy: Detection of Auto-Heparinization as a Marker of Endotheliopathy Using Rotational Thromboelastometry
by Alexandru Emil Băetu, Liliana Mirea, Cristian Cobilinschi, Ioana Cristina Grințescu and Ioana Marina Grințescu
J. Clin. Med. 2024, 13(14), 4219; https://doi.org/10.3390/jcm13144219 - 19 Jul 2024
Cited by 2 | Viewed by 1372
Abstract
Background/Objectives: The complexity of trauma-induced coagulopathy (TIC) is a result of the unique interactions between the patient, trauma, and resuscitation-related causes. The main objective of trauma resuscitation is to create the optimal milieu for both the development of immediate reparatory mechanisms and [...] Read more.
Background/Objectives: The complexity of trauma-induced coagulopathy (TIC) is a result of the unique interactions between the patient, trauma, and resuscitation-related causes. The main objective of trauma resuscitation is to create the optimal milieu for both the development of immediate reparatory mechanisms and the prevention of further secondary injuries. Endotheliopathy represents one of the hallmarks of trauma-induced coagulopathy, and comprises endothelial dysfunction, abnormal coagulation, and inflammation, all of which arise after severe trauma and hemorrhagic shock. Methods: We retrospectively and descriptively evaluated 217 patients admitted to the Bucharest Clinical Emergency Hospital who met the Berlin criteria for the diagnosis of multiple trauma. Patients with high suspicion of auto-heparinization were identified according to the dynamic clinical and para-clinical evolution and subsequently tested using rotational thromboelastometry (ROTEM). The ratio between the clot formation time (CT) was used, obtained on the two channels of interest (INTEM/HEPTEM). Results: Among the 217 patients with a mean age of 43.43 ± 15.45 years and a mean injury severity score (ISS) of 36.98 ± 1.875, 42 patients had a reasonable clinical and para-clinical suspicion of auto-heparinization, which was later confirmed by the INTEM/HEPTEM clotting time ratio in 28 cases (12.9% from the entire study population). A multiple linear regression analysis highlighted that serum lactate (estimated 0.02, p = 0.0098) and noradrenaline requirement (estimated 0.03, p = 0.0053) influenced the CT (INTEM/HEPTEM) ratio. Conclusions: There is a subset of multiple trauma patients in which the CT (INTEM/HEPTEM) ratio was influenced only by serum lactate levels and patients’ need for vasopressor use, reinforcing the relationship between shock, hypoperfusion, and clotting derangements. This emphasizes the unique response that each patient has to trauma. Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 2nd Edition)
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Review

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22 pages, 966 KiB  
Review
Myokine Secretion Dynamics and Their Role in Critically Ill Patients: A Scoping Review
by Yorschua Jalil, L. Felipe Damiani, Patricio García-Valdés, Roque Basoalto, Julen Gallastegui and Ruvistay Gutierrez-Arias
J. Clin. Med. 2025, 14(9), 2892; https://doi.org/10.3390/jcm14092892 - 23 Apr 2025
Viewed by 334
Abstract
Background/Objectives: Myokines can modulate organ function and metabolism, offering a protective profile against ICU complications beyond preventing local muscle wasting. This scoping review aims to explore and summarize the evidence regarding the secretion of myokines and their potential local or systemic effects in [...] Read more.
Background/Objectives: Myokines can modulate organ function and metabolism, offering a protective profile against ICU complications beyond preventing local muscle wasting. This scoping review aims to explore and summarize the evidence regarding the secretion of myokines and their potential local or systemic effects in critically ill patients. Methods: A scoping review following Joana Briggs Institute recommendations was conducted. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, CINAHL (EBSCOhost), WoS, and Scopus was conducted from inception to February 2023. We included primary studies evaluating myokine secretion/concentration in critically ill adults undergoing physical rehabilitation interventions. Two independent reviewers performed study selection and data extraction. Results: Seventeen studies published between 2012 and 2023 were included. Most were randomized clinical trials (47%). Physical rehabilitation interventions included electrical muscle stimulation, as well as passive and active mobilization, delivered alone or combined, in single or daily sessions lasting 20–60 min. Twelve studies (70%) evaluated interleukin-6, while interleukin-10, tumour necrosis factor-α, Interleukin-8, and myostatin were also commonly studied. Thirteen studies (76%) reported changes in myokine secretion or gene expression, although no clear concentration change pattern emerged. Myokines involved in muscle protein synthesis and breakdown may protect against muscle waste and weakness. Conclusions: The study of myokine dynamics in critically ill patients highlights the systemic impact of physical rehabilitation. This emerging field has grown in interest over the past decade, offering significant research potential. However, challenges such as study design, small sample sizes, and variability in physical therapy protocols hinder a comprehensive understanding of myokine responses. Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 2nd Edition)
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Other

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3 pages, 198 KiB  
Comment
Comment on Băetu et al. Beyond Trauma-Induced Coagulopathy: Detection of Auto-Heparinization as a Marker of Endotheliopathy Using Rotational Thromboelastometry. J. Clin. Med. 2024, 13, 4219
by Herbert Schöchl, Nikolaus Hofmann and Johannes Zipperle
J. Clin. Med. 2025, 14(4), 1037; https://doi.org/10.3390/jcm14041037 - 7 Feb 2025
Viewed by 375
Abstract
With great interest, we read the recent study by Baetu et al [...] Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 2nd Edition)
12 pages, 2481 KiB  
Systematic Review
Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients with Acute Decompensated Heart Failure: A Meta-Analysis
by Song Peng Ang, Jia Ee Chia, Vikash Jaiswal, Muhammad Hanif and Jose Iglesias
J. Clin. Med. 2024, 13(5), 1212; https://doi.org/10.3390/jcm13051212 - 21 Feb 2024
Cited by 8 | Viewed by 1838
Abstract
Background: Inflammation plays a pivotal role in the pathogenesis of both acute and chronic heart failure. Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) could be related to adverse outcomes in patients with cardiovascular diseases. We sought to evaluate whether NLR could predict [...] Read more.
Background: Inflammation plays a pivotal role in the pathogenesis of both acute and chronic heart failure. Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) could be related to adverse outcomes in patients with cardiovascular diseases. We sought to evaluate whether NLR could predict mortality in patients with acute heart failure by means of a meta-analysis. Methods: A comprehensive literature search was performed in PubMed, Embase, and Cochrane databases through January 2023 for studies evaluating the association of NLR with mortality in patients with acute heart failure. Primary outcomes were in-hospital mortality and long-term all-cause mortality. Endpoints were pooled using a random-effects DerSimonian-and-Laird model and were expressed as a hazard ratio (HR) or mean difference (MD) with their corresponding 95% confidence intervals. Results: A total of 15 studies with 15,995 patients with acute heart failure were included in the final study. Stratifying patients based on a cut-off NLR, we found that high NLR was associated with a significantly higher in-hospital mortality [HR 1.54, 95% CI (1.18–2.00), p < 0.001] and long-term all-cause mortality [HR 1.61, 95% CI (1.40–1.86), p < 0.001] compared to the low-NLR group. Comparing the highest against the lowest NLR quartile, it was shown that patients in the highest NLR quartile has a significantly heightened risk of long-term all-cause mortality [HR 1.77, 95% CI (1.38–2.26), p < 0.001] compared to that of lowest NLR quartile. However, the risks of in-hospital mortality were compared between both quartiles of patients [HR 1.78, 95% CI (0.91–3.47), p = 0.09]. Lastly, NLR values were significantly elevated among non-survivors compared to survivors during index hospitalization [MD 5.07, 95% CI (3.34–6.80), p < 0.001] and during the follow-up period [MD 1.06, 95% CI (0.54–1.57), p < 0.001]. Conclusions: Elevated NLR was associated with an increased risk of short- and long-term mortality and could be a useful tool or incorporated in the risk stratification in patients with acute heart failure. Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 2nd Edition)
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