Life | Special Issue : Critical Issues in Intensive Care Medicine

Research

13 pages, 536 KB

Open AccessArticle

Interleukin-6 in Daily Use in the Intensive Care Unit: Does It Change the Patients’ Outcome and Antimicrobial Prescription? An Explorative Study

by Tobias Bexten, Rumen Kasabov, Stefan Bushuven, Anne Kamphausen, Verena Schneider-Lindner and Holger A. Lindner

Life 2026, 16(4), 590; https://doi.org/10.3390/life16040590 - 1 Apr 2026

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Abstract

Background: Interleukin-6 (IL-6) rises rapidly during systemic inflammation and is used in some ICUs as a daily infection marker. Whether routine IL-6 monitoring affects patient outcomes or antimicrobial use, compared with standard biomarkers CRP/PCT, remains unclear. Methods: This retrospective two-step study was conducted [...] Read more.

Background: Interleukin-6 (IL-6) rises rapidly during systemic inflammation and is used in some ICUs as a daily infection marker. Whether routine IL-6 monitoring affects patient outcomes or antimicrobial use, compared with standard biomarkers CRP/PCT, remains unclear. Methods: This retrospective two-step study was conducted at a tertiary interdisciplinary ICU in Wiesbaden, Germany. Step 1 (pilot cohort) compared two 2-month periods with routine IL-6 versus CRP/PCT testing to identify differences and generate assumptions. Step 2 (extended cohort) compared two consecutive 12-month periods before and after discontinuation of IL-6 testing. After matching for disease severity and specialty, endpoints included ICU length of stay, ventilation hours, mortality, and antimicrobial use measured as defined daily doses (DDD), and recommended daily doses (RDD) per 100 patient-days. Results: Results: In the pilot cohort (n = 221), there were no significant differences between the IL-6 and CRP/PCT groups in terms of anti-infective therapy or ventilation hours. In the extended cohort (n = 5146), case-matched analyses showed no significant group differences in ICU length of stay, ventilation hours, or mortality between groups. Antimicrobial consumption was higher when IL-6 was used: DDD (16.8% increase, rate ratio RR = 1.17, 95% CI (1.14, 1.19), p < 0.001) and RDD (11.6% increase, RR = 1.12, 95% CI (1.09, 1.14), p < 0.001). Conclusions: In this exploratory study, routine IL-6 testing was not associated with improved outcomes but might be linked to increased antimicrobial consumption. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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13 pages, 818 KB

Open AccessArticle

Postoperative Antibiotic Escalation After Major Free-Flap Reconstruction Requiring ICU Admission: Associations with Day-1 Procalcitonin, Shock, and Microbiological Positivity

by Wei-Hung Chang, Kuang-Hua Cheng, Ting-Yu Hu, Hui-Fang Hsieh and Kuan-Pen Yu

Life 2026, 16(2), 204; https://doi.org/10.3390/life16020204 - 26 Jan 2026

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Abstract

Major reconstructive free-flap surgery often requires ICU admission, yet early signals associated with postoperative antibiotic escalation remain poorly characterized. We conducted a single-center retrospective cohort study of 119 consecutive postoperative ICU admissions after major free-flap reconstruction. Exposures were postoperative day-1 procalcitonin (PCT) and [...] Read more.

Major reconstructive free-flap surgery often requires ICU admission, yet early signals associated with postoperative antibiotic escalation remain poorly characterized. We conducted a single-center retrospective cohort study of 119 consecutive postoperative ICU admissions after major free-flap reconstruction. Exposures were postoperative day-1 procalcitonin (PCT) and documented postoperative shock; the primary endpoint was clinician-initiated antibiotic escalation (“upgrade”), and secondary endpoints were documented microbiological positivity and ICU mechanical ventilation duration. Escalation occurred in 85/119 admissions (71.4%). Day-1 PCT was higher with escalation (median 0.25 vs. 0.135 ng/mL; p = 0.033), and shock was more frequent (59/85 [69.4%] vs. 13/34 [38.2%]; p = 0.003). Escalation was associated with longer ventilation (median 3515 vs. 2170 min; p < 0.001) and higher rates of any positive culture (54/85 [63.5%] vs. 8/34 [23.5%]; p < 0.001). In multivariable logistic regression adjusting for operative time and intraoperative IV volume, shock remained independently associated with escalation (adjusted OR 3.52, 95% CI 1.48–8.36; p = 0.004), whereas log-transformed PCT was not (p = 0.224). PCT showed modest apparent discrimination for escalation (AUC 0.63), improving to 0.71 when combined with shock. These findings should be interpreted as observational associations with escalation behavior, supporting prospective evaluation of physiology-plus-biomarker stewardship approaches. Full article

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17 pages, 1297 KB

Open AccessArticle

Microbiological and Infection-Source Predictors of Mortality in Severe Sepsis Patients Undergoing Polymyxin B Hemoperfusion: A Seven-Year Real-World Cohort Study

by Wei-Hung Chang, Li-Kuo Kuo, Kuan-Pen Yu and Ting-Yu Hu

Life 2026, 16(1), 121; https://doi.org/10.3390/life16010121 - 13 Jan 2026

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Abstract

Background: The microbiological landscape and infection-source profiles of severe sepsis in Asian ICUs differ markedly from Western cohorts and may influence the effectiveness and prognosis of adjunctive therapies such as polymyxin B hemoperfusion (PMX-HP). However, real-world data on how pathogen categories, multidrug resistance [...] Read more.

Background: The microbiological landscape and infection-source profiles of severe sepsis in Asian ICUs differ markedly from Western cohorts and may influence the effectiveness and prognosis of adjunctive therapies such as polymyxin B hemoperfusion (PMX-HP). However, real-world data on how pathogen categories, multidrug resistance (MDR), and infection sources affect outcomes in PMX-HP-treated patients are lacking. Methods: We conducted a retrospective cohort study in a tertiary medical ICU in Taiwan, including adult patients with severe sepsis or septic shock who received PMX-HP between 2013 and 2019. Microbiological data, infection sources, MDR profiles, organ support requirements, vasoactive–inotropic score (VIS), and mortality outcomes were retrieved from electronic records. Pathogen groups (Gram-negative, Gram-positive, fungal, no-growth), MDR status, and infection sources were analyzed for associations with 28-day, ICU, and hospital mortality. Results: Among 64 patients (mean age 66.1 years; 67.2% male), Gram-negative pathogens predominated (70.3%), with Escherichia coli (31.3%) and Klebsiella pneumoniae (21.9%) being the most frequently identified organisms. MDR organisms were isolated in 26.6% of patients. The most common infection sources were pneumonia (29.7%), intra-abdominal infection (18.8%), and urinary tract infection (17.2%). Gram-negative infections were associated with higher CRRT utilization (71.9% vs. 47.1%, p = 0.04) and higher VIS at 24 h. MDR status was significantly associated with early CRRT requirement (64.7% vs. 38.6%, p = 0.048), but not with 28-day mortality (52.9% vs. 43.2%, p = 0.42). No infection source was independently associated with mortality after adjustment for APACHE II, CRRT, and VIS. Instead, greater organ failure severity—particularly renal failure requiring CRRT—was strongly associated with mortality in this cohort. Conclusions: In PMX-HP-treated severe sepsis patients, Gram-negative predominance and MDR status were associated with increased organ support requirements but were not independently associated with mortality. Outcomes were primarily associated with overall illness severity rather than microbiological category. These findings highlight the importance of combining microbiological data with dynamic physiological markers for prognostic risk stratification in Asian ICUs. Full article

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14 pages, 759 KB

Open AccessArticle

The Relationship Between Preoperative Serum Ionized Calcium, Vitamin D, and Postoperative Bleeding After Major Cardiac Surgery

by Adrian Stef, Constantin Bodolea, Aurelia Georgeta Solomonean, Nadina Tintiuc, Alexandru Oprea, Oana Antal, Gabriel Cismaru and Emanuel Palade

Life 2025, 15(9), 1460; https://doi.org/10.3390/life15091460 - 17 Sep 2025

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Abstract

Objective: The role of calcium in coagulation homeostasis is well established, although the relationship between calcium levels and postoperative bleeding in major cardiac surgery remains largely unexplored. Methods: This retrospective, single-center study investigated the correlations between ionized calcium levels measured at several timepoints: [...] Read more.

Objective: The role of calcium in coagulation homeostasis is well established, although the relationship between calcium levels and postoperative bleeding in major cardiac surgery remains largely unexplored. Methods: This retrospective, single-center study investigated the correlations between ionized calcium levels measured at several timepoints: preoperatively (after induction of anesthesia), immediately after cardiopulmonary bypass (CPB) weaning, on the first postoperative day measured three times at 8 h intervals, preoperative vitamin D values, and several significant bleeding outcomes. These outcomes included the volume of blood in the drainage bag (measured in milliliters on days 1 and 2), the need for surgical or medical hemostasis, the requirement for blood transfusion (red blood cells, fresh frozen plasma, or platelets), and the occurrence of extracardiac hemorrhagic complications. A multivariable logistic regression analysis was performed, with a two-sided p-value of <0.00625 considered significant after applying Bonferroni correction. Results: The study included 83 patients with a mean age of 64.9 ± 8.5 years, with 49 (59%) being male. The most common procedures were aortic valve replacement (26 patients, 31%) and coronary artery bypass grafting (26 patients, 31%). The multivariable regression analysis demonstrated a trend toward an association between low levels of preoperative calcium and increased bleeding volume immediately after CBP and on the first day after the intervention (r = 0.30; p = 0.08 for day 1 and r = 0.24; p = 0.03 for day 2). Similar trends were observed for the association between low levels of preoperative calcium, use of medical hemostasis (r = 0.30; p = 0.009), and red blood cell transfusion (r = 0.24; p = 0.03). Additionally, we observed a trend towards a positive correlation between lower serum vitamin D levels and increased postoperative blood loss on both day 1 (r = 0.32; p = 0.07) and day 2 (r = 0.29; p = 0.04). The subgroup analysis of valve procedures vs. coronary procedures showed no statistically difference between preoperative ionized calcium levels, postoperative bleeding (289 27 vs. 283 mL, p = 0.87), the need for surgical hemostasis (p = 0.5), or blood transfusion requirement (p = 0.57). Conclusions: In our study, preoperative calcium levels were consistently associated with increased bleeding after major cardiac surgery. Post-CPB ionized calcium levels did not influence bleeding outcomes. The role of calcium in coagulation homeostasis during major cardiac surgery warrants further research, ideally with more robust data, as our study’s small sample limits robust evidence. Further larger studies will conclude on the importance of calcium levels in cardiac surgery related to hemostasis and bleeding outcomes. Lower preoperative ionized calcium and vitamin D levels showed exploratory associations with increased bleeding-related outcomes following major cardiac surgery. These findings are hypothesis-generating, and larger prospective studies are needed to confirm these potential relationships and clarify their clinical implications. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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13 pages, 856 KB

Open AccessArticle

Outcomes of Traumatic Liver Injuries at a Level-One Tertiary Trauma Center in Saudi Arabia: A 10-Year Experience

by Nawaf AlShahwan, Saleh Husam Aldeligan, Salman T. Althunayan, Abdullah Alkodari, Mohammed Bin Manee, Faris Abdulaziz Albassam, Abdullah Aloraini, Ahmed Alburakan, Hassan Mashbari, Abdulaziz AlKanhal and Thamer Nouh

Life 2025, 15(7), 1138; https://doi.org/10.3390/life15071138 - 19 Jul 2025

Cited by 1 | Viewed by 2420

Abstract

Traumatic liver injury remains a significant contributor to trauma-related morbidity and mortality worldwide. In Saudi Arabia, motor vehicle accidents (MVAs) are the predominant mechanism of injury, particularly among young adults. This study aimed to evaluate the clinical characteristics, management strategies, and outcomes of [...] Read more.

Traumatic liver injury remains a significant contributor to trauma-related morbidity and mortality worldwide. In Saudi Arabia, motor vehicle accidents (MVAs) are the predominant mechanism of injury, particularly among young adults. This study aimed to evaluate the clinical characteristics, management strategies, and outcomes of patients with liver trauma over a ten-year period at a tertiary academic level-one trauma center. A retrospective cohort study was conducted from January 2015 to December 2024. All adult patients (aged 18–65 years) who sustained blunt or penetrating liver injuries and underwent a pan-CT trauma survey were included. Demographic data, Injury Severity Scores (ISSs), imaging timelines, management approach, and clinical outcomes were analyzed. Statistical analysis was performed using JASP software with a significance threshold set at p < 0.05. A total of 111 patients were included, with a mean age of 33 ± 12.4 years; 78.1% were male. MVAs were the leading cause of injury (75.7%). Most patients (80.2%) had low-grade liver injuries and received non-operative management (NOM), with a high NOM success rate of 94.5%. The median time to CT was 55 ± 64 min, and the mean time to operative or IR intervention was 159.9 ± 78.8 min. Complications occurred in 32.4% of patients, with ventilator-associated pneumonia (19.8%) being most common. The overall mortality was 6.3%. Multivariate analysis revealed that shorter time to CT significantly reduced mortality risk (OR = 0.5, p < 0.05), while a positive e-FAST result was strongly associated with increased mortality (OR = 3.3, p < 0.05). Higher ISSs correlated with longer monitored unit stays (ρ = 0.3, p = 0.0014). Traumatic liver injuries in this cohort were predominantly low-grade and effectively managed conservatively, with favorable outcomes. However, delays in imaging and operative intervention were observed, underscoring the requirement for streamlined trauma workflows. These findings highlight the requirement for continuous trauma system improvement, including protocol optimization and timely access to imaging and surgical intervention. Full article

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16 pages, 743 KB

Open AccessArticle

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

Cited by 3 | Viewed by 3723

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

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8 pages, 221 KB

Open AccessArticle

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

Cited by 2 | Viewed by 1231

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 KB

Open AccessArticle

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

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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

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Review

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13 pages, 2522 KB

Open AccessReview

Vein of Galen Malformation—Experience of the Last 13 Years in a Reference Center from South-Eastern Europe

by Ana Mihaela Bizubac, Maria Alexandra Fleaca, Mariana Carmen Herișeanu, Carmina Nedelcu, Alexandra Bratu, Veronica Marcu, Cristina Filip and Cătălin Cîrstoveanu

Life 2025, 15(10), 1536; https://doi.org/10.3390/life15101536 - 30 Sep 2025

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Abstract

The vein of Galen malformations (VoGMs) is mainly correlated with the retention of an embryonic pattern of vascularity, inducer of vein of Galen dilation, and formation of arteriovenous communications that give rise to the risk of systemic shunting, causing cardiac dysfunction, vascular steal, [...] Read more.

The vein of Galen malformations (VoGMs) is mainly correlated with the retention of an embryonic pattern of vascularity, inducer of vein of Galen dilation, and formation of arteriovenous communications that give rise to the risk of systemic shunting, causing cardiac dysfunction, vascular steal, and venous hypertension. This is a rare cerebral vascular malformation in the newborn, accounting for 1% of all cerebral arteriovenous malformations and occurring in approximately 1 in 25,000–50,000 live births. We review nine cases of newborns diagnosed with vein of Galen malformations (VoGMs) to assess whether this pathology demonstrates a marked improvement over the past 13 years in diagnostic accuracy, treatment approaches, and patient survival rates within our clinic. Medical treatment was focused on providing inotropic support and tightly controlled peripheral and pulmonary vasodilation with the aim of overriding the effects of high output heart failure. Most of the patients underwent liver failure and flow-mediated pulmonary hypertension, while half of the newborns expressed anomalies of the nervous system due to impaired cerebral hemodynamics. Given the unavailability of endovascular treatment in our unit, which predisposes the newborns to a higher vital risk, we recognize the importance of delivering tailored intensive care aimed at maintaining cardiorespiratory and hemodynamic stability until a curative intervention can be performed in a specialized center. Full article

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17 pages, 1223 KB

Open AccessReview

Diagnostic and Therapeutic Particularities of Sepsis in Hemodialysis Patients

by Maria-Daniela Tanasescu, Andrei-Mihnea Rosu, Alexandru Minca, Andreea-Liana Rosu, Maria-Mihaela Grigorie, Delia Timofte and Dorin Ionescu

Life 2025, 15(9), 1488; https://doi.org/10.3390/life15091488 - 22 Sep 2025

Cited by 1 | Viewed by 1905

Abstract

Background: Sepsis is a leading cause of morbidity and mortality among patients receiving maintenance hemodialysis (HD), reflecting a unique combination of immunologic dysfunction, comorbidities, and healthcare-related exposures. Despite advances in dialysis technology and infection control, outcomes for septic HD patients remain disproportionately poor. [...] Read more.

Background: Sepsis is a leading cause of morbidity and mortality among patients receiving maintenance hemodialysis (HD), reflecting a unique combination of immunologic dysfunction, comorbidities, and healthcare-related exposures. Despite advances in dialysis technology and infection control, outcomes for septic HD patients remain disproportionately poor. Objective: This review aims to synthesize current evidence on the epidemiology, risk factors, diagnostic challenges, and treatment considerations of sepsis in HD patients, highlighting persistent vulnerabilities and areas for clinical improvement. Methods: A structured narrative review was conducted, focusing on high-quality cohort studies, surveillance data, and pharmacologic analyses published over the past two decades. The literature search was performed using PubMed, Web of Science, and Google Scholar. A total of 37 studies were included in the final synthesis. Key themes were organized around epidemiologic trends, infection sources, risk modifiers, treatment outcomes, and antimicrobial considerations in the dialysis population. Results: The review found that sepsis in HD patients is multifactorial and systemic. Diabetes, advanced age, and central venous catheters remain strong risk factors, while a substantial proportion of infections arise from non-access-related sources. Mortality rates remain high, often due to delays in recognition, inappropriate empiric therapy, and challenges in antimicrobial dosing. Pharmacokinetic alterations in renal replacement therapy complicate treatment, requiring individualized approaches. Despite variations in infection rates across centers, systemic vulnerabilities—rather than dialysis modality alone—drive outcomes. Conclusions: Sepsis in hemodialysis patients is not solely a hardware-related complication but reflects deeper systemic and immunologic challenges. Improving outcomes will require earlier recognition, tailored antimicrobial strategies, standardized infection control protocols, and broader attention to patient-specific risk factors. Future research should focus on ESRD-adapted sepsis diagnostics and interventional models to reduce infection-related mortality in this high-risk group. Full article

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17 pages, 957 KB

Open AccessReview

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

Cited by 5 | Viewed by 8720

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

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13 pages, 633 KB

Open AccessCase Report

Challenging Retrieval of a Migrated Peripheral Venous Cannula Fragment in an Obstetric Patient: Case Report

by Janos Szederjesi, Leonard Azamfirei, János Levente Turos, Emil Marian Arbănași, Gabriela Șalari and Matild Keresztes

Life 2026, 16(5), 717; https://doi.org/10.3390/life16050717 - 23 Apr 2026

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Intravenous cannulation is a routine procedure in clinical practice but may rarely be complicated by catheter fracture with intravascular fragment retention. Management is particularly challenging in obstetric patients, where both maternal safety and procedural risks must be carefully balanced. We report the case [...] Read more.

Intravenous cannulation is a routine procedure in clinical practice but may rarely be complicated by catheter fracture with intravascular fragment retention. Management is particularly challenging in obstetric patients, where both maternal safety and procedural risks must be carefully balanced. We report the case of a 31-year-old pregnant woman at 21 weeks of gestation admitted for conservative management of preterm prelabor rupture of membranes. Three days after peripheral intravenous catheter placement in the right cephalic vein, catheter fracture with intravascular retention of a fragment was identified. Ultrasound localized the fragment within the cephalic vein, with subsequent migration to the deltopectoral groove. An initial surgical exploration was unsuccessful. Following repeat ultrasound localization, a second surgical procedure performed by an experienced vascular surgeon enabled successful retrieval using a Fogarty catheter. Cephalic vein ligation was performed to prevent further migration. The procedure was completed without complications, and the pregnancy progressed for an additional nine weeks, culminating in preterm delivery of a viable neonate. This case highlights the importance of accurate localization, the need for a stepwise surgical approach after failed initial intervention, and the role of vascular expertise in achieving successful outcomes in complex obstetric patients. Full article

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13 pages, 908 KB

Open AccessCase Report

Too Late to Reverse: An Atypical Postpartum Case of Acute Necrotizing Pancreatitis with Refractory ARDS Despite ECMO Support

by Mihaly Veres, Sanziana Flamind Oltean, Sorin Pascanu, Mihaela Butiulca, Oana Elena Branea, Alexandra Elena Lazar and Bianca Liana Grigorescu

Life 2025, 15(9), 1347; https://doi.org/10.3390/life15091347 - 26 Aug 2025

Cited by 1 | Viewed by 1498

Abstract

During pregnancy and in the postpartum period, several diseases may arise or become exacerbated. Acute pancreatitis incidence during pregnancy is similar to the general population but increases in the first two years after delivery. This case report describes the evolution of necrotizing acute [...] Read more.

During pregnancy and in the postpartum period, several diseases may arise or become exacerbated. Acute pancreatitis incidence during pregnancy is similar to the general population but increases in the first two years after delivery. This case report describes the evolution of necrotizing acute pancreatitis in a 30-year-old woman five months postpartum, with an atypical debut of acute pancreatitis, where the high levels of triglycerides caused by hormonal changes in the late postpartum period overlapped with an underlying hyperlipemia. Despite aggressive, multidisciplinary care, including surgical necrosectomy, continuous renal replacement therapy (CRRT), protective ventilation, and venovenous extracorporeal membrane oxygenation (VV-ECMO), the prognosis was influenced by the hormonal changes both secondary to hypothalamic–pituitary–adrenal dysregulation and the postpartum hormonal changes, leading to an altered inflammatory response, evolution to MODS, ultimately resulting in death. The case highlights the complex interplay between postpartum immune and hormonal changes and the systemic inflammatory response of pancreatitis, emphasizing the critical need for postpartum-specific guidelines in managing acute pancreatitis, particularly regarding early risk stratification in order to prevent this pathology and its complications. Full article

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10 pages, 1847 KB

Open AccessCase Report

Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature

by Buzatu Georgiana Cristina, Sebastian Isac, Geani-Danut Teodorescu, Teodora Isac, Cristina Martac, Cristian Cobilinschi, Bogdan Pavel, Cristina Veronica Andreescu and Gabriela Droc

Life 2025, 15(7), 1084; https://doi.org/10.3390/life15071084 - 10 Jul 2025

Cited by 1 | Viewed by 1723

Abstract

Introduction: Methadone, a synthetic opioid used for opioid substitution therapy (OST), is typically associated with arrhythmias rather than direct myocardial depression. Neurological complications, especially with concurrent antipsychotic use, have also been reported. Acute left ventricular failure in young adults is uncommon and often [...] Read more.

Introduction: Methadone, a synthetic opioid used for opioid substitution therapy (OST), is typically associated with arrhythmias rather than direct myocardial depression. Neurological complications, especially with concurrent antipsychotic use, have also been reported. Acute left ventricular failure in young adults is uncommon and often linked to genetic or infectious causes. We present a rare case of reversible cardiogenic shock and cerebellar insult due to methadone toxicity. Case Presentation: A 37-year-old man with a history of drug abuse on OST with methadone (130 mg/day) was admitted to the ICU with hemodynamic instability, seizures, and focal neurological deficits. Diagnostic workup revealed low cardiac output syndrome and a right cerebellar insult, attributed to methadone toxicity. The patient received individualized catecholamine support. After 10 days in the ICU, he was transferred to a general ward for ongoing cardiac and neurological rehabilitation and discharged in stable condition seven days later. Conclusions: Methadone-induced reversible left ventricular failure, particularly when accompanied by cerebellar insult, is rare but potentially life-threatening. Early recognition and multidisciplinary management are essential for full recovery in such complex toxicological presentations. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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