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New Perspectives of Critical Care Medicine
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New Perspectives of Critical Care Medicine

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Critical Care".

Deadline for manuscript submissions: closed (15 June 2024) | Viewed by 8381

Special Issue Editor

Dr. Carmen Diana Cimpoesu

E-Mail Website
Guest Editor
1. Emergency Department, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
2. Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
Interests: CPR; critical cardiac care; sepsis; trauma; POCUS; point of care biomarkers; emergency intervention

Special Issue Information

Dear Colleagues,

This Special Issue will focus on articles that are likely to be of wide interest to critical care science and be relevant for the care of critically ill patients. The purpose of our work is to showcase clinical studies, systematic reviews, meta-analyses, reviews about advances in therapies and monitoring, implementation science reports, fundamental science studies and health services research related to critical illness and emergency interventions in hospital. The diversity of topics and article types should also reflect the multidisciplinary approach and be relevant for the practice of critical care medicine and for patients' benefits. The topics could cover the following areas: resuscitation, sepsis, trauma, cardiovascular critical care, biomarkers, point of care ultrasonography, emergency medicine.

Dr. Carmen Diana Cimpoesu
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 Personalized Medicine 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

  • CPR
  • critical cardiac care
  • sepsis
  • trauma
  • POCUS
  • point of care biomarkers
  • emergency intervention

Published Papers (7 papers)

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Research

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11 pages, 506 KiB  
Article
Prognostic Association between Injury Severity Score and the Outcomes of Elderly Patients with Trauma in South Korea
by Jae-Guk Kim, Hyun-Young Choi, Gu-Hyun Kang, Yong-Soo Jang, Wonhee Kim, Yoonje Lee and Chiwon Ahn
J. Pers. Med. 2024, 14(7), 674; https://doi.org/10.3390/jpm14070674 - 23 Jun 2024
Viewed by 282
Abstract
This study investigated the impact of the Injury Severity Score (ISS) on treatment approaches and survival outcomes in trauma patients, focusing on comparing elderly (≥65 years) with non-elderly patients. It analyzed adult trauma cases with abnormal Revised Trauma Scores from January to December [...] Read more.
This study investigated the impact of the Injury Severity Score (ISS) on treatment approaches and survival outcomes in trauma patients, focusing on comparing elderly (≥65 years) with non-elderly patients. It analyzed adult trauma cases with abnormal Revised Trauma Scores from January to December 2019, categorizing patients into three severity groups based on ISS: mild (1–8), moderate (9–15), and severe (≥16). The study examined how ISS influenced therapeutic interventions and survival among elderly patients, comparing these outcomes to non-elderly patients using multivariable logistic regression analysis. In 16,336 adult trauma cases out of 52,262 patients, including 4886 elderly and 11,450 non-elderly patients, findings revealed that in the severe group, elderly patients had a lower, though not statistically significant, incidence of surgical or embolization interventions compared to the moderate group, differing from non-elderly patients. No significant differences were observed in the mild group between elderly and non-elderly patients. However, elderly patients had higher intervention rates in the moderate group and lower in the severe group, with significantly lower survival-to-discharge rates in the severe group. The ISS is insufficient for assessing trauma severity in elderly patients. Additional tools are needed for better evaluation and treatment decisions. Full article
(This article belongs to the Special Issue New Perspectives of Critical Care Medicine)
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12 pages, 810 KiB  
Article
Development of a Simple Scoring System for Predicting Discharge Safety from the Medical ICU to Low-Acuity Wards: The Role of the Sequential Organ Failure Assessment Score, Albumin, and Red Blood Cell Distribution Width
by Chang Hwan Seol, Min Dong Sung, Shihwan Chang, Bo Ra Yoon, Yun Ho Roh, Ji Eun Park and Kyung Soo Chung
J. Pers. Med. 2024, 14(6), 643; https://doi.org/10.3390/jpm14060643 - 16 Jun 2024
Viewed by 260
Abstract
Despite advancements in artificial intelligence-based decision-making, transitioning patients from intensive care units (ICUs) to low-acuity wards is challenging, especially in resource-limited settings. This study aimed to develop a simple scoring system to predict ICU discharge safety. We retrospectively analyzed patients admitted to a [...] Read more.
Despite advancements in artificial intelligence-based decision-making, transitioning patients from intensive care units (ICUs) to low-acuity wards is challenging, especially in resource-limited settings. This study aimed to develop a simple scoring system to predict ICU discharge safety. We retrospectively analyzed patients admitted to a tertiary hospital’s medical ICU (MICU) between July 2016 and December 2021. This period was divided into two phases for model development and validation. We identified risk factors associated with unexpected death within 14 days of MICU discharge and developed a predictive scoring system that incorporated these factors. We verified the system’s performance using validation data. In the development cohort, 522 patients were discharged from the MICU, and 42 (8.04%) died unexpectedly. In multivariate analysis, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.13–1.41), red blood cell distribution width (RDW) (OR 1.20, 95% CI 1.07–1.36), and albumin (OR 0.37, 95% CI 0.16–0.84) were predictors of unexpected death. Each variable was assigned a weighted point in the scoring system, and the area under the curve (AUC) was 0.788 (95% CI 0.714–0.855). The scoring system was performed using an AUC of 0.738 (95% CI 0.653–0.822) in the validation cohort of 343 patients with 9.62% of unexpected deaths. When a cut-off of 0.032 was applied, a sensitivity and a specificity of 81.8% and 55.2%, respectively, were achieved. This simple bedside predictive score for ICU discharge uses the SOFA score, albumin level, and RDW to aid in timely decision-making and optimize critical care facility allocation in resource-limited settings. Full article
(This article belongs to the Special Issue New Perspectives of Critical Care Medicine)
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14 pages, 656 KiB  
Article
Target Temperature Management Effect on the Clinical Outcome of Patients with Out-of-Hospital Cardiac Arrest Treated with Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Observational Study
by Jae-Hee Kim, Jae-Guk Kim, Gu-Hyun Kang, Yong-Soo Jang, Wonhee Kim, Hyun-Young Choi, Yoonje Lee and Chiwon Ahn
J. Pers. Med. 2024, 14(2), 185; https://doi.org/10.3390/jpm14020185 - 7 Feb 2024
Viewed by 1062
Abstract
This study aimed to investigate whether targeted temperature management (TTM) could enhance outcomes in patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Using a nationwide OHCA registry, adult patients with witnessed OHCA of presumed cardiac [...] Read more.
This study aimed to investigate whether targeted temperature management (TTM) could enhance outcomes in patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Using a nationwide OHCA registry, adult patients with witnessed OHCA of presumed cardiac origin who underwent ECPR at the emergency department between 2008 and 2021 were included. We examined the effect of ECPR with TTM on survival and neurological outcomes at hospital discharge using propensity score matching and multivariable logistic regression compared with patients treated with ECPR without TTM. Odds ratios and 95% confidence intervals were determined. A total of 399 ECPR cases were analyzed among 380,239 patients with OHCA. Of these, 330 underwent ECPR without TTM and 69 with TTM. After propensity score matching, 69 matched pairs of patients were included in the analysis. No significant differences in survival and good neurological outcomes between the two groups were observed. In the multivariable logistic regression, no significant differences were observed in survival and neurological outcomes between ECPR with and without TTM. Among the patients who underwent ECPR after OHCA, ECPR with TTM did not improve outcomes compared with ECPR without TTM. Full article
(This article belongs to the Special Issue New Perspectives of Critical Care Medicine)
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11 pages, 1232 KiB  
Article
Bone Cement Implantation Syndrome: A Rare Disaster Following Cemented Hip Arthroplasties—Clinical Considerations Supported by Case Studies
by Flaviu Moldovan
J. Pers. Med. 2023, 13(9), 1381; https://doi.org/10.3390/jpm13091381 - 15 Sep 2023
Cited by 6 | Viewed by 1436
Abstract
Severe symptoms such as hypoxemia, hypotension, and unexpected loss of consciousness may develop during surgical interventions that use polymethyl methacrylate (PMMA), or as it is commonly known, bone cement. Physicians recognize this amalgam of clinical manifestations more and more as a distinct entity [...] Read more.
Severe symptoms such as hypoxemia, hypotension, and unexpected loss of consciousness may develop during surgical interventions that use polymethyl methacrylate (PMMA), or as it is commonly known, bone cement. Physicians recognize this amalgam of clinical manifestations more and more as a distinct entity that bears the name of bone cement implantation syndrome (BCIS). Trauma cases, especially hip fractures, are seen to have a higher incidence of developing this complication compared to orthopedic elective ones. This research aims to present a detailed description of six severe BCIS cases in order to raise awareness and to emphasize its importance. Five of them had fatal outcomes, which demonstrate the necessity of future research on this topic, as little is known about it presently. In the Discussion section, a narrative overview from the scientific literature is performed on potential risk factors, prevention measures, and management strategies. The experience gathered through this case series may aid medical staff in the development of diagnostic and therapeutic protocols, thus improving safety when cemented surgical techniques are used on a high-risk group of patients. Full article
(This article belongs to the Special Issue New Perspectives of Critical Care Medicine)
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12 pages, 530 KiB  
Article
Arterial Blood Gas Analysis for Survival Prediction in Pediatric Patients with Out-of-Hospital Cardiac Arrest
by Sang-Hwan Lee, Hyungoo Shin, Yongil Cho, Jaehoon Oh, Hyuk-Joong Choi and The Korean Cardiac Arrest Research Consortium (KoCARC) Investigators
J. Pers. Med. 2023, 13(7), 1061; https://doi.org/10.3390/jpm13071061 - 28 Jun 2023
Viewed by 1348
Abstract
Arterial blood gas analysis (ABGA) is one of the few tests performed during cardiopulmonary resuscitation (CPR). There have been some studies on the prediction of survival outcomes in adult out-of-hospital cardiac arrest (OHCA) patients during CPR using ABGA results. However, in pediatric OHCA [...] Read more.
Arterial blood gas analysis (ABGA) is one of the few tests performed during cardiopulmonary resuscitation (CPR). There have been some studies on the prediction of survival outcomes in adult out-of-hospital cardiac arrest (OHCA) patients during CPR using ABGA results. However, in pediatric OHCA patients, the prognosis of survival outcome based on ABGA results during CPR remains unclear. We retrospectively analyzed prospectively collected data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry, a multicenter OHCA registry of Republic of Korea. We analyzed 108 pediatric (age < 19 years) OHCA patients between October 2015 and June 2022. Using multivariable logistic regression, an adjusted odds ratio (aOR) was obtained to validate the ABGA results of survival to hospital admission and survival to discharge. The variables associated with survival to hospital admission were non-comorbidities (aOR 3.03, 95% confidence interval (CI) 1.22–7.53, p = 0.017) and PaO2 > 45.750 mmHg (aOR 2.69, 95% CI 1.13–6.42, p = 0.026). There was no variable that was statistically significant association with survival to discharge. PaO2 > 47.750 mmHg and non-comorbidities may serve as an independent prognostic factor for survival to hospital admission in pediatric OHCA patients. However, the number of cases analyzed in our study was relatively small, and there have been few studies investigating the association between ABGA results during CPR and the survival outcome of pediatric OHCA patients. Therefore, further large-scale studies are needed. Full article
(This article belongs to the Special Issue New Perspectives of Critical Care Medicine)
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Review

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18 pages, 3272 KiB  
Review
The Omics Complexity in Sepsis: The Limits of the Personalized Medicine Approach
by Sebastian Isac, Teodora Isac, Maria Daniela Tanasescu, Bogdan Pavel, Cristina Veronica Andreescu, Andrada-Georgiana Badea, Damiana Ojog, Geani-Danut Teodorescu, Anca Laceanu, Cristian-Bogdan Trifan and Gabriela Droc
J. Pers. Med. 2024, 14(3), 225; https://doi.org/10.3390/jpm14030225 - 20 Feb 2024
Viewed by 2396
Abstract
Sepsis is one of the most common causes of morbidity and mortality worldwide. Despite the remarkable advances in modern medicine throughout the last century, the mortality rates associated with sepsis have remained significantly elevated, both in high- and low-income countries. The main difficulty [...] Read more.
Sepsis is one of the most common causes of morbidity and mortality worldwide. Despite the remarkable advances in modern medicine throughout the last century, the mortality rates associated with sepsis have remained significantly elevated, both in high- and low-income countries. The main difficulty in the diagnosis and treatment of septic patients is the tremendous heterogeneity of this condition. The vast heterogeneity that characterizes sepsis ranges from the clinical presentation to the biological aspects of the disease. Evidence-based medicine approaches sepsis as a homogenous syndrome and does not consider the individual discrepancies between septic patients. This approach may contribute to the poor outcomes of septic patients. In recent years, personalized medicine has gained significant interest. This novel form of medicine underlines the importance of understanding the genetic, epigenetic, and molecular basis of a disease in order to provide a more tailored approach for the patient. The study of “omics”, such as cytomics, genomics, epigenomics, transcriptomics, proteomics, and metabolomics, provides a deeper comprehension of the complex interactions between the host, the disease, and the environment. The aim of this review is to summarize the potential role of a personalized approach in sepsis management, considering the interactions between various “omics”. Full article
(This article belongs to the Special Issue New Perspectives of Critical Care Medicine)
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Other

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6 pages, 373 KiB  
Case Report
Administration of Intravenous Lipid Emulsion for Dextromethorphan Poisoning with Serotonin Syndrome: A Case Report
by Tsukasa Kuwana, Kosaku Kinoshita, Minori Mizuochi, Jun Sato, Nobutaka Chiba, Takeshi Saito and Toru Imai
J. Pers. Med. 2024, 14(3), 242; https://doi.org/10.3390/jpm14030242 - 24 Feb 2024
Cited by 1 | Viewed by 1072
Abstract
Dextromethorphan (DXM) is used to treat colds and coughs; however, it can cause central nervous system symptoms, such as severe serotonin syndrome (SS). To our knowledge, there is no specific treatment for severe DXM poisoning, and there are no reports on the clinical [...] Read more.
Dextromethorphan (DXM) is used to treat colds and coughs; however, it can cause central nervous system symptoms, such as severe serotonin syndrome (SS). To our knowledge, there is no specific treatment for severe DXM poisoning, and there are no reports on the clinical use of intravenous lipid emulsion (ILE) for its treatment. Herein, we report a case of severe DXM poisoning with SS that was successfully treated with ILE. An older adolescent male visited the emergency department 1 h after ingesting 4500 mg of DXM orally. Physical examination revealed generalized convulsions, muscle rigidity, mydriasis (8.0/8.0 mm), and flushed skin, with a Glasgow Coma Scale score of 8 (E3V1M4). Severe DXM poisoning with SS was diagnosed. The patient was intubated and administered midazolam for continuous convulsions and SS. Activated charcoal was also administered, and body surface cooling was performed. After an 11 h intensive care unit admission, SS with mydriasis (6.0/6.0 mm) did not improve. Subsequently, 1100 mL of 20% soybean oil was injected as an ILE. Mydriasis improved (3.5/3.5 mm) 30 min after ILE administration; simultaneously, blood DXM concentration rapidly increased approximately two-fold. After discontinuing midazolam, the patient’s consciousness signs improved, and he was weaned off the ventilator. SS was cured with no recurrence of convulsions. In cases of DXM poisoning with severe central nervous system disorders, such as SS, ILE treatment can potentially be an effective therapeutic option. For oral overdose cases, where the drug may remain in the intestinal tract, measures such as administering activated charcoal should be taken before administering ILE. Full article
(This article belongs to the Special Issue New Perspectives of Critical Care Medicine)
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