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Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 9686

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Special Issue Editors

Dr. Silvius Ioan Negoiţǎ

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Guest Editor

1. Elias Emergency University Hospital of Bucharest, Bucharest, Romania
2. Department of Anesthesia and Intensive Care Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Interests: mechanical ventilation; critical care medicine; airway management; resuscitation; cardiopulmonary resuscitation; intensive care medicine; pain management; ARDS; sepsis

Dr. Dan E. Corneci

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Guest Editor

1. Dr. Carol Davila Central University Emergency Military Hospital of Bucharest, Bucharest, Romania
2. Department of Anesthesia and Intensive Care Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Interests: intensive care; mechanical ventilation; renal replacement therapy; ARDS; sepsis; acute respiratory failure; organ dysfunction; shock; neuroanesthesia; one-lung ventilation; open-lung ventilation; VILI; P-SILI
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Dr. Emanuel Moisa

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Guest Editor Assistant

1. Elias Emergency University Hospital of Bucharest, Bucharest, Romania
2. Department of Anesthesia and Intensive Care Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Interests: hemodynamics; critical care medicine; septic shock; sepsis; mechanical ventilation; airway management; anesthesia; cardiopulmonary resuscitation; biostatistics; predictive models; organ dysfunction; ARDS; point-of-care ultrasound

Special Issue Information

Dear Colleagues,

We invite you to contribute to this Special Issue, "Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care", which aims to showcase the latest developments and collaborative strategies in patient care within the fields of anesthesiology and critical care medicine. This Special Issue will discuss the integration of various medical disciplines and the application of recent research, technologies, and practices that impact patient outcomes and safety in the perioperative and intensive care environment.

The fields of anesthesiology and critical care are evolving rapidly, necessitating the hand-in-hand expertise of diverse healthcare professionals. Recent advancements in patient monitoring techniques, drug research, and day-to-day clinical practice make a multidisciplinary approach mandatory to effectively manage patients with complex pathological conditions. This Special Issue seeks to investigate the potential of these advancements when leveraged through collaborative efforts to improve patient care, optimize treatment protocols, and foster innovation within the practice.

We invite authors to contribute with original research papers, and all types of review articles, including systematic reviews and meta-analyses that explore a wide range of topics related to recent advancements and multidisciplinary approaches in anesthesiology and critical care. We seek to include, but authors are not limited to, the following topics: (1) innovative anesthetic techniques; (2) technological advancements and patient safety in anesthesia, perioperative medicine, and critical care environments; (3) enhanced recovery after surgery (ERAS); (4) multidisciplinary management of critically ill patients; (5) point-of-care monitoring techniques; and (6) education, training, and ethical aspects in the practice of anesthesia and critical care medicine. This Special Issue is addressed to all medical practitioners of anesthesia and critical care, as well as to all professionals working in other related medical specialties.

Dr. Silvius Ioan Negoiţǎ
Dr. Dan E. Corneci
Guest Editors

Dr. Emanuel Moisa
Guest Editor Assistant

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. Medicina 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 2200 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

general anesthesia
regional anesthesia
intensive care medicine
patient safety
perioperative medicine
ERAS
point-of-care ultrasound
medical simulation
personalized medicine

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Published Papers (6 papers)

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Research

11 pages, 277 KB

Open AccessArticle

Drug Monitoring of Therapy with Midazolam in Patients with ARDS: A Single-Center Prospective Study

by Marek Grochla, Marcin Basiak, Bogusław Okopień and Piotr Knapik

Medicina 2026, 62(4), 742; https://doi.org/10.3390/medicina62040742 - 13 Apr 2026

Viewed by 447

Abstract

Background and Objectives: One of the two primary classes of drugs administered in ICUs for pharmacological sedation is benzodiazepines. Among these, anesthesiologists consider midazolam the most commonly used and clinically significant agent. Materials and Methods: A prospective, single-center investigation involving 25 patients was carried out in the ICU. The study population consisted of patients undergoing mechanical ventilation with an FiO₂ exceeding 60%, as well as ventilated individuals requiring additional support such as ECMO, NO, or ECCOR over 24 h before the study. Participants under 18 years of age or those not receiving continuous midazolam infusion were excluded. Measurements obtained from RASS and BIS were then compared with serum midazolam concentrations. On each day, when blood samples for midazolam measurements were taken, additional laboratory tests assessing renal and hepatic function were also carried out. Results: A negative correlation was shown between RASS and midazolam dosage (r = −0.44, p < 0.001), midazolam concentration (r = −0.33, p < 0.001), and α-OH-midazolam concentration (r = −0.24, p = 0.008). Similarly, a negative correlation was shown between BIS and midazolam concentration (r = −0.3, p = 0.016), as well as α-OH-midazolam (r = −0.3, p = 0.016). We observed that deceased patients received higher doses of midazolam to maintain the minimum level of required sedation compared to the others (135.5 ± 75.1 mg vs. 39.6 ± 59.2 mg; p = 0.002), indicating that these patients had higher concentrations of both midazolam and α-OH-midazolam (148.6 ± 83.5 µg/L vs. 27.2 ± 36.1 µg/L; p < 0.001, and 18 ± 15.9 vs. 5.3 ± 6.1 µg/L; p < 0.001). Conclusions: The results show that routine monitoring of midazolam does not provide additional clinical value. However, further studies are needed in high-risk groups. Despite the high mortality rate in the ICU for patients with severe respiratory failure, the six-month survival rate for discharged patients was high, exceeding 80%. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care)

24 pages, 2674 KB

Open AccessArticle

One Index Does Not Predict All—Hematological Derived Indices Have Different Predictive Value for ICU Mortality in Critically Ill Patients with Non-Infectious Versus Infectious Acute Exacerbation of COPD

by Emanuel Moisa, Silvius Ioan Negoita, Claudia Mihail, Liviu Ioan Serban, Alexandru Tudor Steriade, Cristian Cobilinschi, Madalina Dutu, Georgeana Tuculeanu and Dan Corneci

Medicina 2026, 62(4), 728; https://doi.org/10.3390/medicina62040728 - 10 Apr 2026

Viewed by 452

Abstract

Background and Objectives: Acute exacerbation of COPD (AECOPD) poses a major burden on healthcare systems, with critically ill AECOPD patients having increased morbidity and mortality. Since adverse outcomes are due both to respiratory failure and the systemic inflammatory response, prognostic markers accounting for these patterns are needed. Our aim was to investigate the predictive power of derived hematological indices for intensive care unit (ICU) mortality in patients with non-infectious versus infectious AECOPD. Materials and Methods: This is a retrospective, observational, monocentric cohort study on 88 AECOPD patients admitted to the ICU between 2018 and 2023. Descriptive statistics were performed for the entire cohort, and for predefined subgroups (non-infectious, infectious and bacterial AECOPD). Receiver Operating Characteristics (ROC) analysis was performed to test the predictive power of the studied indices. Cut-off values were identified using the Youden index. Kaplan–Meier analysis was conducted to test the association with ICU mortality. Results: Overall ICU mortality was 44%. For the whole cohort, neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelets ratio (NPR) and systemic inflammation response index (SIRI) showed moderate predictive power for ICU mortality (areas under the curve (AUCs) of 0.71–0.73). Non-infectious and infectious subgroups were comparable in terms of size, demographics, comorbidities and baseline COPD characteristics (p > 0.05). Mortality was significantly higher in infectious AECOPD (64.6% versus 20%, p < 0.001). For non-infectious AECOPD, monocyte-to-lymphocyte ratio (MLR) and SIRI had very good predictive power (AUCs between 0.82 and 0.855), while NPR and systemic inflammation index (SII) showed moderate AUC values (between 0.7 and 0.79). In infectious AECOPD, only NPR retained fair predictive power (AUC 0.691), which improved in bacterial AECOPD (AUC 0.781). Conclusions: Derived hematological indices have different predictive values for ICU mortality. MLR and SIRI exhibited very good predictive power in non-infectious AECOPD, while NPR was the best discriminator in bacterial AECOPD. These stress the importance of individualized prognostication in AECOPD. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care)

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12 pages, 656 KB

Open AccessArticle

Distinct Trajectories of Consciousness Recovery During Targeted Temperature Management in Out-of-Hospital Cardiac Arrest Survivors: A Cluster Analysis

by Hyo Joon Kim, Sang Hoon Oh, Kyu Nam Park and Jee Yong Lim

Medicina 2026, 62(3), 427; https://doi.org/10.3390/medicina62030427 - 24 Feb 2026

Viewed by 519

Abstract

Background and Objectives: Static prognostication in comatose out-of-hospital cardiac arrest (OHCA) survivors may overlook delayed recovery, risking premature withdrawal of life-sustaining therapy (WLST). This study aimed to identify distinct longitudinal phenotypes of consciousness recovery and determine the prevalence and characteristics of the Late Awakener phenotype. Materials and Methods: We applied K-means clustering to serial Glasgow Coma Scale motor scores (0, 24, 48, 72 h, Day 5) in 417 adult OHCA survivors treated with targeted temperature management at Seoul St. Mary’s Hospital (2009–2023). Results: Three distinct phenotypes emerged: Early Awakeners (n = 86, 20.6%), Late Awakeners (n = 54, 12.9%), and Non-Awakeners (n = 277, 66.4%). While Early Awakeners had 96.5% good neurological outcomes at 6 months, 79.6% of Late Awakeners also achieved good outcomes despite being indistinguishable from Non-Awakeners at 48 h (mean GCS motor score ≤ 2). Late Awakeners had significantly higher rates of shockable rhythms (72.2% vs. 21.3%, p < 0.001) compared to Non-Awakeners. Conclusions: The identification of a Late Awakener phenotype—comprising 13% of the cohort and one-third of all survivors with good outcomes—challenges early prognostic pessimism. An extended observation window of at least 5–7 days may be warranted for patients with shockable rhythms to avoid premature WLST, even when early motor responses are absent. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care)

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14 pages, 482 KB

Open AccessArticle

Prognostic Value of the National Early Warning Score Combined with Nutritional and Endothelial Stress Indices for Mortality Prediction in Critically Ill Patients with Pneumonia

by Ferhan Demirer Aydemir, Murat Daş, Özge Kurtkulağı, Ece Ünal Çetin, Feyza Mutlay and Yavuz Beyazıt

Medicina 2026, 62(1), 207; https://doi.org/10.3390/medicina62010207 - 19 Jan 2026

Viewed by 711

Abstract

Background and Objectives: Pneumonia is a leading cause of intensive care unit (ICU) admission and is associated with high mortality, particularly among patients with multiple comorbidities. Accurate early risk stratification is essential for guiding clinical decision-making in critically ill patients. However, the prognostic benefit of combining clinical scoring systems with nutritional and endothelial stress indices in ICU patients with pneumonia remains unclear. Materials and Methods: This retrospective, single-center cohort study included adult patients admitted to the ICU with a diagnosis of pneumonia between 1 January 2023 and 1 July 2025. Demographic characteristics, comorbidities, clinical variables, laboratory parameters, and prognostic scores were obtained from electronic medical records. The National Early Warning Score (NEWS), Prognostic Nutritional Index (PNI), and Endothelial Activation and Stress Index (EASIX) were calculated at ICU admission. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to examine variables associated with in-hospital mortality. The discriminative performance of individual and combined prognostic models was evaluated using receiver operating characteristic (ROC) curve analysis. Results: A total of 221 patients were included; 79 (35.7%) survived and 142 (64.3%) died during hospitalization. Non-survivors had significantly higher NEWS and EASIX values and lower PNI values compared with survivors (all p < 0.05). In multivariate analysis, endotracheal intubation (OR: 12.46; p < 0.001), inotropic use (OR: 5.14; p = 0.001), and serum lactate levels (OR: 1.75; p = 0.003) were identified as being independently associated with in-hospital mortality. Models combining NEWS with PNI or EASIX demonstrated improved discriminatory performance. Conclusions: In critically ill patients with pneumonia, integrating NEWS with nutritional and endothelial stress indices provides numerically improved discrimination compared with NEWS alone, although the incremental gain did not reach statistical significance. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care)

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13 pages, 1069 KB

Open AccessArticle

Resistance Dynamics in a Romanian Critical Care Unit: Four Years of ESKAPE Pathogen Surveillance

by Mihai Sava, Ioana Roxana Codru, Alina Simona Bereanu, Oana Stoia and Bogdan Ioan Vintila

Medicina 2025, 61(12), 2114; https://doi.org/10.3390/medicina61122114 - 27 Nov 2025

Cited by 1 | Viewed by 690

Abstract

Background and Objectives: Antimicrobial resistance is one of the most significant threats to modern healthcare, especially in intensive care units where ESKAPE pathogens—Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.—account for the majority of healthcare-associated infections. Romania is among the European countries with the highest rates of antimicrobial consumption and resistance. This study aimed to describe the epidemiological trends and antimicrobial resistance profiles of ESKAPE isolates over a four-year period (2021–2024) in a Romanian ICU (Intensive Care Unit). Materials and Methods: We conducted a retrospective observational study of all microbiological samples collected from adult ICU patients at the Clinical Emergency County Hospital of Sibiu between 2021 and 2024. Data were extracted from the electronic laboratory system and included patient demographics, specimen types, isolated microorganisms, and antimicrobial resistance classifications. Statistical analyses were performed using Python libraries, with significance set at p < 0.05. Results: A total of 801 infections were recorded, of which 562 (70.2%) involved ESKAPE pathogens. The predominant organisms identified were Klebsiella pneumoniae (42.8%) and Acinetobacter baumannii (36.0%), followed by Pseudomonas aeruginosa (11.2%). Nearly half of the isolates (47.3%) were multidrug-resistant, and 22.3% were extensively drug-resistant. Respiratory specimens, particularly tracheal aspirates, accounted for the majority of the isolates and exhibited the highest proportion of resistant phenotypes. A significant temporal increase in extensively drug-resistant isolates was observed over the study period (p < 0.05). Conclusions: ESKAPE pathogens remain the leading causes of ICU infections in Romania, with Klebsiella pneumoniae and Acinetobacter baumannii contributing significantly to the burden of multidrug- and extensively drug-resistant infections. Strengthening infection prevention strategies, optimizing antimicrobial stewardship, and implementing continuous microbiological surveillance are essential to mitigate the evolving resistance crisis in Romanian critical care settings. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care)

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11 pages, 727 KB

Open AccessArticle

Laboratory and Microbiological Considerations in Sepsis-Induced Cardiac Dysfunction

by Catalina Paraschiv, Denisa Oana Nicolaescu, Mihaela Roxana Popescu, Carmen Cristina Vasile, Emanuel Moisa, Silvius Ioan Negoita and Serban Mihai Balanescu

Medicina 2025, 61(10), 1765; https://doi.org/10.3390/medicina61101765 - 30 Sep 2025

Cited by 1 | Viewed by 1285

Abstract

Introduction: Sepsis-induced cardiac dysfunction (SICD) is a transient cardiac disfunction, with variable described prevalence and uncertain prognostic. This study aimed to characterize the laboratory and microbiological findings in critically ill patients with sepsis who developed left ventricular (LV) or biventricular systolic dysfunction. Methods: Patients who required intensive care unit hospitalization for sepsis were screened retrospectively. Only patients with positive cultures and echocardiography performed within 24 h from admission were included. The exclusion criteria were infective endocarditis, acute coronary syndrome, history of cardiomyopathy, severe valve disease, end-stage organ or oncological disease. Cardiac function was appreciated on transthoracic echocardiography, using LV ejection fraction for the left ventricle and tricuspid annular plane systolic excursion (TAPSE) for the right ventricle. SICD was confirmed if the systolic dysfunction found upon admission was reversible within 7–10 days. Results: A total of 100 patients with positive cultures were included. The median age was 73 and 55% were male. SICD was diagnosed in 14% of patients. Patients with SICD were more likely to develop septic shock and had longer hospital and intensive care unit stay. In-hospital mortality was 44% with no significant difference between SICD and non-SICD patients. Laboratory markers upon hospital admission showed that SICD patients had significantly higher values of lactate and transaminases. Cardiac (troponin and NT-proBNP) and inflammation markers (leukocytes, neutrophils, NLR, C-reactive protein, procalcitonin) had higher values in patients with SICD but the difference did not reach statistical significance. Streptococcal infections and polymicrobial cultures were risk factors for developing SICD. Higher rates of infections with Enterobacterales were seen in the SICD group but the difference was not significant. Conclusions: SICD patients had higher lactate, inflammation, and cardiac biomarkers levels upon admission and significantly higher rates of streptococcal infections and polymicrobial cultures. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care)

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