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Emergency and Critical Care in the Context of Personalized Medicine

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Medical Care".

Deadline for manuscript submissions: 25 April 2026 | Viewed by 8543

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Special Issue Editors

Dr. Raffaele Aspide

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Guest Editor

IRCCS Istituto delle Scienze Neurologiche di Bologna, Anesthesia and Neurointensive Care Unit, Bologna, Italy
Interests: acquired brain injury; neuroanesthesia; neurocritical care; optic nerve sheath diameter; Doppler ultrasonography; neuro monitoring
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Daniele Biasucci

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Guest Editor

Department of Clinical Science and Translational Medicine, “Tor Vergata” University of Rome, 00133 Rome, Italy
Interests: mechanical ventilation; critical care medicine; resuscitation; cardiopulmonary resuscitation; sepsis; airway management; intensive care medicine; emergency management; emergency treatment; ventilation

Special Issue Information

Dear Colleagues,

Critically ill patients are currently framed within very complex algorithms and protocols, the furthest thing from personalized medicine. This happens when critical medicine tries to use the results of large trials and available guidelines to obtain the best possible outcome. However, not all fit for all patients. For example, maintaining mean arterial blood pressure at physiological levels can differ greatly if we are treating a healthy young person compared to a patient suffering from arterial hypertension. Protective ventilation can differ depending on the initial quality of the lungs. The management of sepsis and temperature are closely linked to the individual metabolism of the patient.

Beyond the macroscopic therapeutic differences between adult and pediatric patients, today it is increasingly essential to "measure" the intensity of care also on the wishes expressed for well-being by the patient, or to consider what degree of disability the patient and his caregivers can consider acceptable after extremely critical pathological conditions. This Special Issue is dedicated to all the literature, which focuses on the aspects of tailored critical care. Journal articles, reviews, and communications are welcomed.

Dr. Raffaele Aspide
Prof. Dr. Daniele Biasucci
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-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 Personalized Medicine is an international peer-reviewed open access monthly 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 care medicine
emergency medicine
emergency care
neurocritical care
sepsis
anesthesia

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Published Papers (6 papers)

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Research

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12 pages, 401 KB

Open AccessArticle

Association of oXiris^® Therapy with Lower Vasopressor Requirements and Modulation of Hemodynamic, Inflammatory, and Perfusion Markers in Septic Shock: A Retrospective Cohort Study

by Nazrin Bakhshaliyeva, Fernando Ramasco Rueda, Ana Estiragués Barreiro and Miguel Ángel Olmos Alonso

J. Pers. Med. 2025, 15(12), 626; https://doi.org/10.3390/jpm15120626 - 14 Dec 2025

Viewed by 698

Abstract

Background: Septic shock remains a critical challenge with high mortality, particularly in refractory cases requiring high doses of vasopressors. Hemoadsorption with the oXiris^® membrane, capable of simultaneously removing endotoxins, cytokines, and damage-associated molecular patterns (DAMPs), represents a personalized therapeutic strategy targeting the underlying pathophysiology. However, clinical evidence on its impact remains limited and lacks consensus. This study aims to analyze the effects of oXiris^® therapy on hemodynamic, inflammatory, and perfusion parameters in a real-world cohort of patients with septic shock. Methods: We conducted a retrospective cohort study in a surgical Intensive Care Unit (ICU) at a tertiary hospital, including 45 adult patients with septic shock treated with continuous renal replacement therapy using the oXiris^® membrane for at least 48 h. The institutional protocol involved filter changes at least every 24 h during the first 48 h of therapy. Hemodynamic variables, vasopressor doses, and biochemical markers were collected at baseline (T0), 24 h (T1), and 48 h (T2). The primary objective was to describe the evolution of these parameters. Secondary objectives included analysis of 30-day mortality and identification of prognostic factors. Results: The cohort consisted of 45 patients (80.0% male, median age 71 years), with a predominance of abdominal infectious focus (71.1%). A significant reduction in median norepinephrine requirements was observed from T0 to T2 (p < 0.00001), along with a significant increase in mean arterial pressure (MAP) (p < 0.00001). Key markers of perfusion and inflammation also improved, with a significant decrease in arterial lactate (p < 0.00001) and procalcitonin (p = 0.00082) at 48 h. No significant changes were observed in the Sequential Organ Failure Assessment (SOFA) score. The observed mortality rate in the ICU was 31.1%, lower than the median predicted mortality by Simplified Acute Physiology Score II (SAPS II) (37%). Baseline Charlson Comorbidity Index (CCI), creatinine, arterial lactate, and SOFA score were independent predictors of mortality. Conclusions: In this cohort of septic shock patients, therapy with oXiris^®, applied with a frequent filter exchange protocol, was associated with a significant reduction in vasopressor requirements and an improvement in key hemodynamic, perfusion, and inflammatory markers. The observed ICU mortality was lower than predicted by severity scores. These findings support the role of oXiris^® as a personalized adjuvant therapy in specific septic shock phenotypes and underscore the need for prospective randomized trials to confirm these benefits. Full article

(This article belongs to the Special Issue Emergency and Critical Care in the Context of Personalized Medicine)

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10 pages, 1335 KB

Open AccessArticle

Identifying Patients at Increased Risk for Poor Outcomes Among Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients: The IPOGRO Risk Model

by Rustici Arianna, Scibilia Antonino, Linari Marta, Zoli Matteo, Zenesini Corrado, Belotti Laura Maria Beatrice, Sturiale Carmelo, Conti Alfredo, Aspide Raffaele, Castioni Carlo Alberto, Mazzatenta Diego, Princiotta Ciro, Dall’Olio Massimo, Bortolotti Carlo and Cirillo Luigi

J. Pers. Med. 2024, 14(11), 1070; https://doi.org/10.3390/jpm14111070 - 24 Oct 2024

Cited by 1 | Viewed by 1474

Abstract

Background: A subarachnoid hemorrhage due to an aneurysmal rupture (aSAH) is a serious condition with severe neurological consequences. The World Federation of Neurosurgical Societies (WFNS) classification is a reliable predictor of death and long-term disability in patients with aSAH. Poor-grade neurological conditions on admission in aSAH (PG-aSAH) are often linked to high mortality rates and unfavorable outcomes. However, more than one-third of patients with PG-aSAH may recover and have good functional outcomes if aggressive treatment is provided. We developed a risk model called Identifying POor GRade Outcomes (IPOGRO) to predict 6-month mRS outcomes in PG-aSAH patients as a secondary analysis of a previously published study. Methods: All consecutive patients in poor-grade neurological conditions (WFNS IV-V) admitted to our institute from 2010 to 2020 due to aSAH were considered. Clinical and neuroradiological parameters were employed in the univariable analysis to evaluate the relationship with a 6-month modified Rankin Scale (mRS). Then, a multivariable multinomial regression model was performed to predict 6-month outcomes. Results: 149 patients with PG-aSAH were included. Most patients were surgically treated, with only 33.6% being endovascularly treated. The 6-month mRS score was significantly associated with clinical parameters on admission, such as lowered Glasgow Coma Scale (GCS), leukocytosis, hyperglycemia, raised Systolic Blood Pressure (SBP), greater Simplified Acute Physiology Score (SAPS II score), increased initial serum Lactic Acid (LA) levels, and the need for Norepinephrine (NE) administration. Neuroradiological parameters on the initial CT scan showed a significant association with a worsening 6-month mRS. The IPOGRO risk model analysis showed an association between a WFNS V on admission and a poor outcome (mRS 4-5), while raised SBP was associated with mortality. Conclusions: Our IPOGRO risk model indicates that PG-aSAH patients with higher SBP at admission had an increased risk of death at 6-month follow-up, whereas patients with WFNS grade V at admission had an increased risk of poor outcome but not mortality. Full article

(This article belongs to the Special Issue Emergency and Critical Care in the Context of Personalized Medicine)

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16 pages, 1463 KB

Open AccessArticle

Evaluating Thrombolysis Rates and Emergency Department Time Targets in Acute Ischemic Stroke: Need for Personalized Medicine

by Daian Ionel Popa, Florina Buleu, Carmen Williams, Anca Tudor, Dumitru Sutoi, Cosmin Iosif Trebuian, Covasala Constantin Ioan, Dragoș Forțofoiu, Marius Badalica-Petrescu, Ion Petre, Aida Iancu and Ovidiu Alexandru Mederle

J. Pers. Med. 2024, 14(9), 955; https://doi.org/10.3390/jpm14090955 - 9 Sep 2024

Cited by 2 | Viewed by 2053

Abstract

Background and objectives: In the era of personalized medicine, standard protocols regarding the management of acute ischemic stroke (AIS) focus on time targets alone without tailoring the protocol to the specific patient and hospital characteristics to increase IV thrombolysis rates and improve outcomes for these patients by considering organizational differences and patient-related factors that influence adherence to target times at the emergency department level. With this in mind, we evaluate the effect of achieving ED time targets from standard protocol and patient-related risk factors on the intravenous (IV) thrombolysis rate in patients with AIS in the therapeutic window. Materials and Methods: For our research, we enrolled people who arrived at the ED with signs of recent AIS with an onset of less than 4.5 h. Initially, 355 patients were included in the study, but through careful screening, only 258 were considered eligible to participate. Of the final group of 258 patients, only 46 received intravenous thrombolysis treatment. Results: In our study, when we are analyzing ED times in patients admitted with stroke symptoms in the therapeutic window, we found statistically significantly decreased ED times for patients that performed IV thrombolysis compared to patients not performing as follows: a median of 100 min in onset-to-ED door time (p < 0.001), a door-to-physician time (ED doctor) of 4 min (p = 0.009), door-to-blood-samples of 5 min (p = 0.026), a door-to-CT time of 15.5 min (p = 0.009), and door-to-CT results of 37 min (p < 0.001). In addition, patients who received intravenous thrombolysis were found to be significantly older (p < 0.001), with lower height and weight (p < 0.001 for both) and lower Glasgow Coma Scale (GCS) scores (9 ± 4.94 vs. 13.85 ± 2.41, p < 0.001). The logistic regression analysis indicated that the onset-to-ED time (p < 0.001) and the door-to-physician time (p = 0.014) for emergency medicine physicians are significant predictors of the likelihood of administering thrombolysis. By analyzing the impact of comorbidities, we observed that dyslipidemia, chronic arterial hypertension, and diabetes mellitus are significant predictive factors for performing IV thrombolysis (the presence of dyslipidemia and diabetes mellitus are predictive factors for performing IV thrombolysis, while the presence of arterial hypertension is not). Conclusions: The ED time targets that significantly influenced IV thrombolysis in our study were the onset-to-ED door time and the time it takes for the ED doctor to assess the AIS patient (door-to-physician time). The IV thrombolysis rate for these patients was 17.83%, lower than expected despite achieving most ED time targets, with the presence of chronic arterial hypertension as a significant predictive patient-related factor for not performing it. Even though our reported hospital’s thrombolysis rate is favorable compared to international reports, there is always room for improvement. Based on our study results, it is necessary that new protocols to customized standard protocols and ED time targets for increasing IV thrombolysis rate in patients with AIS in the therapeutic window, focusing more on patient-related factors and type of hospitals, granting personalized medicine its right. Based on our study results, it is necessary that new protocols customize standard protocols and ED time targets for increasing IV thrombolysis rate in patients with AIS in the therapeutic window, focusing more on patient-related factors and type of hospitals, granting personalized medicine its right. Full article

(This article belongs to the Special Issue Emergency and Critical Care in the Context of Personalized Medicine)

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Review

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20 pages, 339 KB

Open AccessReview

One Score Fits All? A Narrative Review on Early Warning Scores for Older Adults in the Emergency Department in the Era of Personalized Medicine

by Valeria Maccauro, Piergiacomo Maria Cacciamani Fanelli, Davide Antonio Della Polla, Nicola Bonadia, Giuseppe De Matteis, Andrea Piccioni, Antonio Gasbarrini, Claudio Sandroni, Francesco Franceschi and Marcello Covino

J. Pers. Med. 2026, 16(2), 98; https://doi.org/10.3390/jpm16020098 - 6 Feb 2026

Viewed by 490

Abstract

Background: The growing use of Emergency Departments (EDs) by older adults highlights the need for early and accurate identification of clinical deterioration. Early Warning Scores (EWSs) are widely implemented tools based on standardized vital sign thresholds; however, their performance in elderly patients is inconsistent, likely reflecting the biological heterogeneity, multimorbidity, and reduced physiological reserve typical of this population. Objectives: This narrative review aims to summarize current evidence on the use of EWSs in adults aged ≥ 65 years presenting to the ED, with a specific focus on mortality and intensive care unit (ICU) admission, and to discuss their role within the evolving framework of personalized medicine. Sources: A narrative review of 36 clinical studies published between 2014 and 2025 was conducted. Content: Traditional scores such as National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), Modified Early Warning Score (MEWS), VitalPAC Early Warning Score (ViEWS), Rapid Acute Physiology Score (RAPS) and Rapid Emergency Medicine Score (REMS) show variable and often reduced prognostic accuracy in older and frail patients. Evidence consistently suggests that applying uniform cut-off values fails to capture individual vulnerability in elderly patients. The integration of age, frailty, comorbidities, and baseline physiological status improves risk stratification. Second-generation tools—including Copeptin-NEWS, NEWS-L, suPAR-NEWS, OPERA, and RISE UP—as well as artificial intelligence-based models, represent emerging personalized approaches to clinical deterioration prediction. Implications: No single score currently provides reliable early risk prediction for all elderly ED patients. Moving beyond “one-size-fits-all” EWSs toward adaptive, person-centered models may better reflect the complexity of geriatric emergency care and improve prognostic accuracy. Full article

(This article belongs to the Special Issue Emergency and Critical Care in the Context of Personalized Medicine)

34 pages, 2274 KB

Open AccessReview

Deep Biological Clocks in Critical Care Medicine: A Scoping Review Toward Translational Precision Care

by Ithamar Cheyne, Magdalena Voinič, Tara Radaideh, Abdullah Daher, Julia Niezgoda, Maja Anna Romanowska and Małgorzata Mikaszewska-Sokolewicz

J. Pers. Med. 2026, 16(2), 92; https://doi.org/10.3390/jpm16020092 - 4 Feb 2026

Viewed by 584

Abstract

Background: Outcomes after critical illness vary markedly despite similar diagnoses and severity scores, underscoring the limitations of chronological age and conventional Intensive Care Unit (ICU) prognostic tools. Personalization of critical care is increasingly essential to improve not only short-term survival but also long-term post-discharge outcomes. Biological aging clocks provide a quantitative framework to capture physiological reserve, immune competence, and vulnerability to stress. Methods: We conducted a scoping review of original human studies published between January 2015 and October 2025 that evaluated biological aging biomarkers in adult ICU populations. PubMed/MEDLINE, Scopus, Web of Science, and Embase were searched, with backward citation screening. Results: Across epigenetic, telomere-based, cfDNA, proteomic, metabolomic, and phenotypic aging measures, accelerated biological aging was consistently associated with increased mortality, organ dysfunction, and post-ICU vulnerability. Despite substantial methodological heterogeneity, a convergent signal emerged linking inflammation-weighted and stress-responsive deep biological clocks to clinically meaningful outcomes in critically ill patients. Conclusions: Biological aging biomarkers represent a mechanistically grounded approach to personalized prognostication in critical care. From a translational perspective, deep biological clocks hold promise for personalized risk stratification, prognostication, and the identification of high-risk recovery phenotypes, although prospective validation and implementation studies are required. Full article

(This article belongs to the Special Issue Emergency and Critical Care in the Context of Personalized Medicine)

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26 pages, 1952 KB

Open AccessReview

Beyond Standard Parameters: Precision Hemodynamic Monitoring in Patients on Veno-Arterial ECMO

by Debora Emanuela Torre and Carmelo Pirri

J. Pers. Med. 2025, 15(11), 541; https://doi.org/10.3390/jpm15110541 - 7 Nov 2025

Cited by 1 | Viewed by 2254

Abstract

Background: Hemodynamic management in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is inherently complex, as extracorporeal circulation profoundly alters preload, afterload, ventriculo-arterial coupling and tissue perfusion. This review summarizes current and emerging monitoring strategies to guide initiation, maintenance and weaning. Methods: A structured literature search was performed in PubMed and Scopus (1990–2025), including clinical studies, consensus statement and expert reviews addressing hemodynamic monitoring in V-A ECMO. Results: A multiparametric framework is required. Echocardiography remains central for assessing biventricular performance, aortic valve dynamics and ventricular unloading. Pulmonary artery catheterization provides complementary data on filling pressures, cardiac output and global oxygen balance. Metabolic indices such as lactate clearance and veno-arterial CO₂ gap, together with regional oximetry (NIRS), inform the adequacy of systemic and tissue perfusion. Microcirculatory monitoring, though technically demanding, has shown prognostic value, particularly during weaning. Additional adjuncts include arterial pulse pressure, end-tidal CO₂ and waveform analysis. Phenotype oriented priorities, such as detection of differential hypoxemia, prevention of left ventricular distension or surveillance for limb ischemia, require tailored monitoring strategies. Artificial intelligence and machine learning represent future avenues for integrating multiparametric data into predictive models. Conclusions: No single modality can capture the hemodynamic complexity of V-A ECMO. Precision monitoring demands a dynamic, phenotype-specific and time-dependent approach that integrates systemic, cardiac, metabolic and microcirculatory variables. Such individualized strategies hold promise to optimize outcomes, reduce complications and align V-A ECMO management with the principles of precision medicine. Full article

(This article belongs to the Special Issue Emergency and Critical Care in the Context of Personalized Medicine)

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