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Life
Special Issues
Critical Issues in Intensive Care Medicine—2nd Edition
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Critical Issues in Intensive Care Medicine—2nd Edition

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: 25 February 2027 | Viewed by 1853

Editor

Dr. Janos Szederjesi

E-Mail Website
Guest Editor
Department of Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540139 Târgu-Mureș, Romania
Interests: intensive care; medical simulation; anesthesiology; sepsis; TIVA-TCI
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Guest Editor is grateful to the many researchers who contributed to the success of the first edition of this Special Issue.

Volume 1: https://www.mdpi.com/journal/life/special_issues/KU3U7J34M4.

We are excited to announce the second volume of our Special Issue in Life, titled “Critical Issues in Intensive Care Medicine—2nd Edition”.

Intensive care medicine faces several critical issues that impact patient outcomes, healthcare delivery, and resource management. One key issue is the rising demand for intensive care due to an aging population, the increased prevalence of chronic diseases, and critical illnesses; this has led to higher ICU requirements and challenges in staffing and bed availability.

The management of infections and rise in antibiotic-resistant pathogens also present problems. ICUs are hotspots for healthcare-associated infections, which can severely affect critically ill patients.

While innovations in technology offer new tools for monitoring and treatment, their cost and implementation and the need for continuous training pose challenges.

This Special Issue aims to enhance patient management in intensive care settings by sharing authors’ experiences and research on critical challenges encountered in daily practice.

We particularly encourage the submission of original articles, reviews, and case reports that investigate physiological pathology, diagnostics, and treatments for critically ill patients.

Topics of interest include, but are not limited to, the following: managing elderly patients, high-risk individuals with multiple comorbidities, addressing hospital-acquired infections and sepsis, managing acute respiratory failure, evaluating and treating hemodynamic instability, navigating end-of-life care, and adapting to new technologies in intensive care.

Dr. Janos Szederjesi
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 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. Life 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 issues
  • intensive care
  • co-morbidities in ICUs
  • new technology issues in ICUs
  • sepsis
  • hospital-acquired infections
  • end of life

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Published Papers (4 papers)

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20 pages, 1326 KB  
Article
Association of oXiris Hemoadsorption with Inflammatory, Hemodynamic, Respiratory, and Organ Dysfunction Parameters in Patients with Sepsis and Septic Shock in the Intensive Care Unit: A Retrospective Comparative Cohort Study
by Semiha Orhan, Murat Ay, Merve Ay and Kemal Yetis Gulsoy
Life 2026, 16(8), 1367; https://doi.org/10.3390/life16081367 - 19 Aug 2026
Viewed by 119
Abstract
Background/Objectives: This study aimed to evaluate the associations of adding oXiris hemoadsorption therapy to standard sepsis treatment with inflammatory markers, organ dysfunction, hemodynamic parameters, respiratory function, and overall survival (OS) in patients with sepsis and septic shock managed in the intensive care unit [...] Read more.
Background/Objectives: This study aimed to evaluate the associations of adding oXiris hemoadsorption therapy to standard sepsis treatment with inflammatory markers, organ dysfunction, hemodynamic parameters, respiratory function, and overall survival (OS) in patients with sepsis and septic shock managed in the intensive care unit (ICU). In our ICU, oXiris was used as adjunctive hemoadsorption for endotoxin and cytokine removal, delivered on a continuous venovenous hemodiafiltration (CVVHDF) platform and initiated independently of acute kidney injury (AKI). Methods: This retrospective comparative cohort study included 83 adult patients with sepsis or septic shock admitted to the Internal Medicine ICU. Patients were allocated to either the oXiris group (n = 33), which received oXiris hemoadsorption for 72 h in addition to standard sepsis therapy, or the control group (n = 50), which received standard sepsis therapy without oXiris or another adsorptive CRRT membrane. Conventional intermittent hemodialysis for independent renal indications was permitted and recorded in both groups. C-reactive protein (CRP), procalcitonin (PCT), white blood cell count, updated Sequential Organ Failure Assessment (SOFA-2) score, PaO2/FiO2 ratio, serum lactate, norepinephrine dose, and renal parameters were recorded at baseline, 48 h, and 72 h. Between-group differences in temporal changes were evaluated using adjusted generalized estimating equation models, and robustness was assessed with a propensity-score-based inverse-probability-of-treatment-weighted (IPTW) sensitivity analysis. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Results: The oXiris group had significantly greater baseline clinical severity, including a higher burden of renal dysfunction. This marked baseline imbalance was considered important when interpreting the unadjusted findings and supported the use of adjusted and IPTW analyses. In the oXiris group, CRP, PCT, SOFA-2 score, and norepinephrine requirement showed greater reductions over time, whereas the PaO2/FiO2 ratio improved significantly. After IPTW adjustment, the between-group differences in SOFA-2 score, norepinephrine requirement, and PaO2/FiO2 ratio remained statistically significant, whereas the CRP and PCT differences were no longer statistically significant. Serum lactate levels showed an increasing trend in the oXiris group compared with the control group (p = 0.042). No significant difference in overall survival was observed between the two groups (p = 0.897). Conclusions: The addition of oXiris hemoadsorption to standard sepsis therapy was associated with favorable early temporal changes in organ dysfunction, norepinephrine requirement, and oxygenation. However, the observed CRP and PCT differences were not preserved after IPTW adjustment, and no survival association was identified. These findings should therefore be interpreted as associations rather than evidence of a causal treatment effect. Full article
(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine—2nd Edition)
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14 pages, 1486 KB  
Article
Comparative Analysis of Novel Inflammatory and Nutritional Indices (m-HALP, HALP, SII, SIRI) for Risk Stratification in Septic Patients: A Retrospective Cohort Study
by Salih Kocaoğlu, Tufan Alatlı, Deniz Sığırlı and Selman Gümüş
Life 2026, 16(8), 1327; https://doi.org/10.3390/life16081327 - 13 Aug 2026
Viewed by 188
Abstract
Background: Reliable biomarkers integrating inflammatory and nutritional status are crucial for sepsis risk stratification. While indices like the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) are widely studied, the prognostic value of the modified Hemoglobin, Albumin, Lymphocyte, and Platelet (m-HALP) [...] Read more.
Background: Reliable biomarkers integrating inflammatory and nutritional status are crucial for sepsis risk stratification. While indices like the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) are widely studied, the prognostic value of the modified Hemoglobin, Albumin, Lymphocyte, and Platelet (m-HALP) score in sepsis remains unclear. This study aimed to compare the prognostic accuracy of m-HALP, HALP, SII, and SIRI for 90-day mortality in patients diagnosed with sepsis in the emergency department. Materials and Methods: This single-center, retrospective observational study included 188 adult patients diagnosed with sepsis according to the Surviving Sepsis Campaign guidelines. Routine hemogram and biochemistry parameters obtained at admission were used to calculate SII, SIRI, HALP, and m-HALP scores. The primary endpoint was 90-day mortality, and secondary endpoints included 7-day mortality, ICU admission, and mechanical ventilation requirement. The discriminative performance of the indices was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: The median age of the cohort was 75.5 years, and the 90-day mortality rate was 49.5%. Among the evaluated indices, only the lower m-HALP scores demonstrated a statistically significant association with 90-day mortality in the overall cohort (AUC: 0.590, 95% CI: 0.509–0.671, p = 0.030). In the pneumosepsis subgroup, the prognostic performance of m-HALP was numerically higher (AUC: 0.667, 95% CI: 0.548–0.785, p = 0.006) with a sensitivity of 57.4% and specificity of 76.7% at a cut-off value of 522.11. Conversely, standard HALP, SII, and SIRI did not show statistically significant predictive value for 90-day mortality (p > 0.05). None of the indices successfully predicted 7-day mortality, ICU admission, or mechanical ventilation requirement. Conclusions: While m-HALP showed a statistically significant association with 90-day mortality, particularly in the pneumosepsis subgroup, its overall discriminative ability was poor-to-modest (overall AUC 0.590; pneumosepsis AUC 0.667). Consequently, m-HALP lacks sufficient accuracy for standalone clinical decision-making, rendering these findings strictly exploratory and hypothesis-generating. Future prospective, multicenter studies are needed to validate this independent association. Full article
(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine—2nd Edition)
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11 pages, 404 KB  
Article
Association of Diabetes Mellitus and Obesity with Early Complications After Surgical Tracheostomy in Critically Ill ICU Patients: A Retrospective Observational Cohort Study
by Lukas S. Fiedler, Tobias Meyer, Fabian Burk and Fynn Roters
Life 2026, 16(8), 1251; https://doi.org/10.3390/life16081251 - 29 Jul 2026
Viewed by 307
Abstract
Background: Obesity and diabetes mellitus (DM) are established risk factors for impaired wound healing, but their associations with early postoperative complications following surgical tracheostomy in critically ill patients remain insufficiently characterized. This study evaluated the associations of obesity and DM with clinically documented [...] Read more.
Background: Obesity and diabetes mellitus (DM) are established risk factors for impaired wound healing, but their associations with early postoperative complications following surgical tracheostomy in critically ill patients remain insufficiently characterized. This study evaluated the associations of obesity and DM with clinically documented early peristomal wound infection following bedside surgical tracheostomy using either the Visor or Björk technique. Methods: This retrospective single-centre cohort study included 92 ICU patients who underwent bedside surgical tracheostomy between 2022 and 2023. Postoperative complications were retrospectively assessed from clinical documentation at postoperative days 5–7 and 10–14. Documentation at days 5–7 was available for all 92 patients, whereas documentation at days 10–14 was available for 78 patients. The analyses therefore evaluated complications documented during the available postoperative follow-up period of up to 14 days rather than complete 14-day cumulative incidence. Associations of obesity and DM with clinically documented peristomal wound infection were assessed using exploratory univariable analyses. Results: Clinically documented peristomal wound infection occurred in 18 of 92 patients (19.6%) during the available postoperative follow-up period. Infection was documented in 10 of 28 patients with obesity (35.7%) compared with 8 of 64 patients without obesity (12.5%; crude OR 3.89, 95% CI 1.33–11.35; Fisher’s exact p = 0.020). Infection was also more frequent in patients with DM (12/31, 38.7%) than in those without DM (6/61, 9.8%; crude OR 5.79, 95% CI 1.91–17.57; Fisher’s exact p = 0.002). Postoperative haemorrhage was numerically more frequent in patients with obesity (14.3% vs. 6.3%), but this association was not statistically significant (crude OR 2.50, 95% CI 0.58–10.78; Fisher’s exact p = 0.242). Conclusions: Obesity and DM were associated with higher crude odds of clinically documented early peristomal wound infection following bedside surgical tracheostomy. Given the exploratory, unadjusted analyses and incomplete follow-up through days 10–14, these findings should be considered hypothesis-generating and require confirmation in larger prospective cohorts. Full article
(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine—2nd Edition)
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13 pages, 4849 KB  
Case Report
Acute Myocardial Infarction Complicated by Papillary Muscle Rupture and Cardiogenic Shock Requiring ECMO Support in a Patient with Bipolar Disorder and Chronic Cannabis Use
by Oana Elena Branea, Mihaly Veres, Oana Frandeș, Matild Keresztes, Mihai Claudiu Pui, Ciprian Fișcă, Radu Bălău and Leonard Azamfirei
Life 2026, 16(6), 879; https://doi.org/10.3390/life16060879 - 24 May 2026
Viewed by 679
Abstract
Cardiogenic shock secondary to acute myocardial infarction complicated by mechanical failure remains associated with high mortality despite advances in cardiac surgery and mechanical circulatory support. We report the case of a 42-year-old patient with posterior papillary muscle rupture leading to severe mitral regurgitation, [...] Read more.
Cardiogenic shock secondary to acute myocardial infarction complicated by mechanical failure remains associated with high mortality despite advances in cardiac surgery and mechanical circulatory support. We report the case of a 42-year-old patient with posterior papillary muscle rupture leading to severe mitral regurgitation, managed with emergency surgical intervention and extracorporeal membrane oxygenation. The patient, with a history of Type I Bipolar Disorder under long-term lithium therapy and chronic Cannabis use, presented in critical condition with cardiogenic shock (Killip IV), acute pulmonary edema, and ST-segment elevation myocardial infarction in the infero-posterior territory. Coronary angiography revealed right coronary artery occlusion and involvement of an obtuse marginal branch. Emergency mitral valve replacement with a mechanical prosthesis and aortocoronary bypass were performed. Due to failure to wean from cardiopulmonary bypass, central veno-arterial ECMO was initiated. The postoperative course was complicated by hemodynamic instability and recurrent pericardial collections requiring repeated surgical interventions and conversion to peripheral ECMO. Multiorgan dysfunction developed, including hepato-renal failure requiring hemofiltration, neurological injury, respiratory impairment, and neuropsychiatric complications. Despite these challenges, progressive recovery was achieved under intensive multidisciplinary management. This case emphasizes the importance of early surgical correction and tailored ECMO support in managing post-infarction mechanical complications. Full article
(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine—2nd Edition)
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