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Key Advances in the Treatment of the Critically III: Part...
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Key Advances in the Treatment of the Critically III: Part II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 1809

Special Issue Editor

Prof. Dr. Spyros D. Mentzelopoulos

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Guest Editor
First Department of Intensive Care Medicine, National and Kapodistrian University of Athens, Evaggelismos General Hospital, 10675 Athens, Greece
Interests: cardiac arrest; postcardiac arrest syndrome; mechanical ventilation; ethics of end-of-life decisions; hospital-acquired infections; airway management
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Intensive Care Medicine (ICM) aims to address organ-system failures in the context of an extremely broad variety of acute and severe disease states and coexisting comorbid conditions. Accordingly, survival without severe disability may vary from <10% to >90%. Despite intense randomized controlled clinical research for several decades, only a handful of key therapeutic interventions have been shown to directly improve important and/or critical patient outcomes. Examples include lung-protective mechanical ventilation and prone positioning in acute respiratory distress syndrome (ARDS), targeted temperature management, amiodarone, and the vasopressin–steroids–epinephrine combination in cardiac arrest, tranexamic acid in trauma (including head injury), and early antibiotics in sepsis/septic shock. Furthermore, the use of bundles of physiologically and pharmacologically sound interventions, such as those recommended in the context of guidelines for sepsis/septic shock, ARDS and postcardiac arrest care, may have also contributed to the observed improvements in outcomes over the past decades.

The severe acute respiratory syndrome coronavirus-2 pandemic has prompted urgent and intensified research on the development of effective treatments such as the messenger RNA-based vaccines, immunomodulating interventions and antiviral pills. Additionally, extracorporeal membrane oxygenation still constitutes a potentially promising intervention for selected patients with treatment-refractory respiratory and/or circulatory failure. Notably, the rapid evolution of evidence-based ethical guidelines and the introduction of palliative care options seem to increasingly augment the consistency between actually administered treatments and patient/family values, goals and preferences.

This Special Issue invites submissions of reviews and original articles related to any of the aforementioned topics related to ICM.

Prof. Dr. Spyros D. Mentzelopoulos
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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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

  • respiration
  • artificial
  • prone position
  • respiratory distress syndrome
  • respiratory insufficiency
  • heart arrest
  • hypothermia
  • induced
  • amiodarone
  • vasopressins
  • steroids
  • epinephrine
  • multiple trauma
  • wounds and injuries
  • tranexamic acid
  • sepsis
  • anti-bacterial agents
  • COVID-19
  • COVID-19 vaccines
  • COVID-19 breakthrough infections
  • COVID-19 drug treatment
  • extracorporeal membrane oxygenation

Related Special Issue

Published Papers (2 papers)

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13 pages, 2141 KiB  
Article
Beyond Trauma-Induced Coagulopathy: Detection of Auto-Heparinization as a Marker of Endotheliopathy Using Rotational Thromboelastometry
by Alexandru Emil Băetu, Liliana Mirea, Cristian Cobilinschi, Ioana Cristina Grințescu and Ioana Marina Grințescu
J. Clin. Med. 2024, 13(14), 4219; https://doi.org/10.3390/jcm13144219 - 19 Jul 2024
Viewed by 497
Abstract
Background/Objectives: The complexity of trauma-induced coagulopathy (TIC) is a result of the unique interactions between the patient, trauma, and resuscitation-related causes. The main objective of trauma resuscitation is to create the optimal milieu for both the development of immediate reparatory mechanisms and [...] Read more.
Background/Objectives: The complexity of trauma-induced coagulopathy (TIC) is a result of the unique interactions between the patient, trauma, and resuscitation-related causes. The main objective of trauma resuscitation is to create the optimal milieu for both the development of immediate reparatory mechanisms and the prevention of further secondary injuries. Endotheliopathy represents one of the hallmarks of trauma-induced coagulopathy, and comprises endothelial dysfunction, abnormal coagulation, and inflammation, all of which arise after severe trauma and hemorrhagic shock. Methods: We retrospectively and descriptively evaluated 217 patients admitted to the Bucharest Clinical Emergency Hospital who met the Berlin criteria for the diagnosis of multiple trauma. Patients with high suspicion of auto-heparinization were identified according to the dynamic clinical and para-clinical evolution and subsequently tested using rotational thromboelastometry (ROTEM). The ratio between the clot formation time (CT) was used, obtained on the two channels of interest (INTEM/HEPTEM). Results: Among the 217 patients with a mean age of 43.43 ± 15.45 years and a mean injury severity score (ISS) of 36.98 ± 1.875, 42 patients had a reasonable clinical and para-clinical suspicion of auto-heparinization, which was later confirmed by the INTEM/HEPTEM clotting time ratio in 28 cases (12.9% from the entire study population). A multiple linear regression analysis highlighted that serum lactate (estimated 0.02, p = 0.0098) and noradrenaline requirement (estimated 0.03, p = 0.0053) influenced the CT (INTEM/HEPTEM) ratio. Conclusions: There is a subset of multiple trauma patients in which the CT (INTEM/HEPTEM) ratio was influenced only by serum lactate levels and patients’ need for vasopressor use, reinforcing the relationship between shock, hypoperfusion, and clotting derangements. This emphasizes the unique response that each patient has to trauma. Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically III: Part II)
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12 pages, 2481 KiB  
Systematic Review
Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients with Acute Decompensated Heart Failure: A Meta-Analysis
by Song Peng Ang, Jia Ee Chia, Vikash Jaiswal, Muhammad Hanif and Jose Iglesias
J. Clin. Med. 2024, 13(5), 1212; https://doi.org/10.3390/jcm13051212 - 21 Feb 2024
Cited by 2 | Viewed by 1107
Abstract
Background: Inflammation plays a pivotal role in the pathogenesis of both acute and chronic heart failure. Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) could be related to adverse outcomes in patients with cardiovascular diseases. We sought to evaluate whether NLR could predict [...] Read more.
Background: Inflammation plays a pivotal role in the pathogenesis of both acute and chronic heart failure. Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) could be related to adverse outcomes in patients with cardiovascular diseases. We sought to evaluate whether NLR could predict mortality in patients with acute heart failure by means of a meta-analysis. Methods: A comprehensive literature search was performed in PubMed, Embase, and Cochrane databases through January 2023 for studies evaluating the association of NLR with mortality in patients with acute heart failure. Primary outcomes were in-hospital mortality and long-term all-cause mortality. Endpoints were pooled using a random-effects DerSimonian-and-Laird model and were expressed as a hazard ratio (HR) or mean difference (MD) with their corresponding 95% confidence intervals. Results: A total of 15 studies with 15,995 patients with acute heart failure were included in the final study. Stratifying patients based on a cut-off NLR, we found that high NLR was associated with a significantly higher in-hospital mortality [HR 1.54, 95% CI (1.18–2.00), p < 0.001] and long-term all-cause mortality [HR 1.61, 95% CI (1.40–1.86), p < 0.001] compared to the low-NLR group. Comparing the highest against the lowest NLR quartile, it was shown that patients in the highest NLR quartile has a significantly heightened risk of long-term all-cause mortality [HR 1.77, 95% CI (1.38–2.26), p < 0.001] compared to that of lowest NLR quartile. However, the risks of in-hospital mortality were compared between both quartiles of patients [HR 1.78, 95% CI (0.91–3.47), p = 0.09]. Lastly, NLR values were significantly elevated among non-survivors compared to survivors during index hospitalization [MD 5.07, 95% CI (3.34–6.80), p < 0.001] and during the follow-up period [MD 1.06, 95% CI (0.54–1.57), p < 0.001]. Conclusions: Elevated NLR was associated with an increased risk of short- and long-term mortality and could be a useful tool or incorporated in the risk stratification in patients with acute heart failure. Full article
(This article belongs to the Special Issue Key Advances in the Treatment of the Critically III: Part II)
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