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Life
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Critical Issues in Intensive Care Medicine
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Critical Issues in Intensive Care Medicine

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

Deadline for manuscript submissions: 22 July 2025 | Viewed by 2834

Special Issue 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 Issue Information

Dear Colleagues,

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 as well as bed availability.

The management of infections and the rise of antibiotic-resistant pathogens are other challenges. ICUs are hotspots for healthcare-associated infections, which can severely affect critically ill patients.

Innovations in technology, while offering new tools for monitoring and treatment, pose challenges regarding their cost, implementation, and the need for continuous training.

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 especially 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 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. 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
  • hospital-acquired infections
  • end of life

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

Published Papers (4 papers)

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Research

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16 pages, 743 KiB  
Article
Morbidity and Mortality Trends in Preterm Neonates at the Limits of Viability: Retrospective Observations from One Greek Hospital
by Dimitra Maria Apostolidi, Maria Kapetanidi, Eleni Vretou, Antigoni Sarantaki, Katerina Lykeridou, Grigorios Karampas, Athina Diamanti, Maria Vlachou, Nikoleta Pantelaki, Anna Deltsidou, Christina Nanou, Stavroula Charoni, Panagiota Katti, Aikaterini Fotiou, Iraklis Salvanos and Dimitra Metallinou
Life 2025, 15(5), 708; https://doi.org/10.3390/life15050708 - 27 Apr 2025
Viewed by 321
Abstract
The survival and health outcomes of extremely preterm neonates (PNs) remain a critical challenge in neonatal intensive care. This 5-year retrospective, observational study evaluated morbidity and mortality trends in PNs born at the limits of viability and identified survival patterns and associated risk [...] Read more.
The survival and health outcomes of extremely preterm neonates (PNs) remain a critical challenge in neonatal intensive care. This 5-year retrospective, observational study evaluated morbidity and mortality trends in PNs born at the limits of viability and identified survival patterns and associated risk factors. It was conducted from 2017 to 2022 on a dataset of PNs born between 22 + 0 and 26 + 0 weeks of gestation in a tertiary public hospital in Greece. A total of 73 PNs were included. The mortality rate was 56.2%. The median gestational age was 24.3 weeks, and the mean birth weight was 603.6 g. Survival improved significantly with a higher gestational age and birth weight. Respiratory distress syndrome was the most prevalent morbidity (71–94%), followed by late-onset sepsis (35.3%) and patent ductus arteriosus (29.4%). The use of antenatal corticosteroids and enteral feeding were associated with improved survival rates. Survivors required prolonged respiratory support and demonstrated better outcomes with early and adequate nutritional support. We conclude that the gestational age, birth weight, and effective respiratory and nutritional interventions are critical determinants of survival in neonates at the limits of viability. Enhancing neonatal care protocols with targeted interventions, such as antenatal corticosteroid use and evidence-based nutritional practices, could significantly improve outcomes in this vulnerable population. Full article
(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)
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8 pages, 221 KiB  
Article
Target-Controlled Sedation with Propofol Infusion for PEG-J Placement in Advanced Parkinson’s Disease: A Prospective Observational Study on Safety and Feasibility
by Janos Szederjesi, Irina Săplăcan, Alexandra Lazăr, Matild Keresztes, Georgiana-Mihaela Muller-Șerban, Jozsef Attila Szasz and Bianca Liana Grigorescu
Life 2025, 15(3), 492; https://doi.org/10.3390/life15030492 - 18 Mar 2025
Viewed by 356
Abstract
Introduction: The management of sedation during percutaneous endoscopic gastrojejunostomy (PEG-J) placement in patients with advanced Parkinson’s disease (PD) is challenging due to the complex interactions between PD treatment, anesthetic agents, and the disease’s motor and non-motor symptoms. This study evaluates the effectiveness and [...] Read more.
Introduction: The management of sedation during percutaneous endoscopic gastrojejunostomy (PEG-J) placement in patients with advanced Parkinson’s disease (PD) is challenging due to the complex interactions between PD treatment, anesthetic agents, and the disease’s motor and non-motor symptoms. This study evaluates the effectiveness and safety of a target-controlled infusion (TCI) propofol protocol in the context of PEG-J placement in advanced PD patients. Materials and Methods: This prospective study included 169 patients diagnosed with advanced Parkinson’s disease (Hoehn and Yahr stages 4 and 5) who underwent PEG-J placement at Târgu Mureș County Emergency Clinical Hospital, Romania. Sedation was induced and maintained using TCI propofol, with additional benzodiazepines and short-acting opioids, while muscle relaxants were not used. Procedural success rates and adverse outcomes were assessed for 30 days post-procedure. Results: The sedation protocol demonstrated a high procedural success rate. No deaths were reported within 30 days post-procedure. Conclusion: This study highlights the feasibility and clinical applicability of a TCI propofol protocol for PEG-J placement in patients with advanced PD (stages 4 and 5). While no deaths were recorded within the 30-day follow-up, the sample size is insufficient to draw definitive conclusions regarding long-term safety. Full article
(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)
13 pages, 1201 KiB  
Article
Fluid Resuscitation and Initial Management in Patients Presenting with Sepsis in the General Ward
by Sung Won Chang, Juwhan Choi, Jee Youn Oh, Young Seok Lee, Kyung Hoon Min, Gyu Young Hur, Sung Yong Lee, Jae Jeong Shim and Jae Kyeom Sim
Life 2025, 15(1), 124; https://doi.org/10.3390/life15010124 - 18 Jan 2025
Viewed by 993
Abstract
The optimal management of hospital-presenting sepsis remains poorly understood. We investigated the initial management in patients presenting with sepsis in the general ward, the association between fluid resuscitation and clinical outcomes, and the factors affecting fluid resuscitation. A retrospective study was conducted on [...] Read more.
The optimal management of hospital-presenting sepsis remains poorly understood. We investigated the initial management in patients presenting with sepsis in the general ward, the association between fluid resuscitation and clinical outcomes, and the factors affecting fluid resuscitation. A retrospective study was conducted on patients who presented with sepsis-induced hypotension in the general ward. Patients were divided into Less 30 (fluid resuscitation less than 30 mL/kg) and More 30 (fluid resuscitation 30 mL/kg or more) groups. Multivariable logistic regression analysis was performed. The median resuscitation fluid volume was 500 mL (9.2 mL/kg) and 2000 mL (35.9 mL/kg) in the Less 30 (n = 79) and More 30 (n = 11) groups, respectively. The intensive care unit (ICU) mortality was similar between the two groups (43.0% vs. 45.5%). Twenty-two patients received continuous renal replacement therapy (CRRT) in the Less 30 group, whereas none received it in the More 30 group (27.8% vs. 0%). Fluid resuscitation ≥30 mL/kg was not associated with ICU mortality. Low body weight and systolic blood pressure were associated with fluid resuscitation ≥30 mL/kg. Most hospital-presenting sepsis patients received less than 30 mL/kg of fluid, and fluid resuscitation was not associated with ICU mortality. Full article
(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)
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Review

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17 pages, 957 KiB  
Review
A New Perspective on Overfeeding in the Intensive Care Unit (ICU): Challenges, Dangers and Prevention Methods
by Vlad-Dimitrie Cehan, Alina-Roxana Cehan, Mihai Claudiu Pui and Alexandra Lazar
Life 2025, 15(5), 828; https://doi.org/10.3390/life15050828 - 21 May 2025
Abstract
Overfeeding, currently defined as providing excessive energy and nutrients beyond metabolic requirements, is a common yet often overlooked issue in the intensive care unit (ICU) setting. Understanding the factors contributing to overfeeding and implementing strategies to prevent it is essential for optimizing patient [...] Read more.
Overfeeding, currently defined as providing excessive energy and nutrients beyond metabolic requirements, is a common yet often overlooked issue in the intensive care unit (ICU) setting. Understanding the factors contributing to overfeeding and implementing strategies to prevent it is essential for optimizing patient care in the ICU. Several factors contribute to overfeeding in the ICU, including inaccurate estimation of energy requirements, formulaic feeding protocols, and failure to adjust nutritional support based on individual patient needs. Prolonged overfeeding can lead to insulin resistance and hepatic dysfunction, exacerbating glycemic control, increasing the risk of infectious complications, and worsening clinical outcomes. Clinically, overfeeding has been linked to delayed weaning from mechanical ventilation, prolonged ICU stay, and increased mortality rates. Regular review and adjustment of feeding protocols, incorporating advances in enteral and parenteral nutrition strategies, are essential for improving patient outcomes. Clinicians must be proficient in interpreting metabolic data, understanding the principles of energy balance, and implementing appropriate feeding algorithms. Interdisciplinary collaboration among critical care teams, including dieticians, physicians, and nurses, is crucial for ensuring consistent and effective nutritional management. Overfeeding remains a significant concern in the ICU after discharge as well, implying further complications for patient safety and integrity. By understanding the causes, consequences, and strategies for the prevention of overfeeding, healthcare providers can optimize nutrition therapy and mitigate the risk of metabolic complications. Through ongoing education, interdisciplinary collaboration, and evidence-based practice, the ICU community can strive to deliver personalized and precise nutritional support to critically ill patients. Full article
(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)
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