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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 (10 August 2023) | Viewed by 18266

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Special Issue Editors

Prof. Dr. Epaminondas Zakynthinos

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Guest Editor

Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece
Interests: critical care; ARDS; mechanical ventilation; sepsis; hemodynamics; echocardiography; arrythmias; cardiomyopathy; neuromonitoring; MODS; COVID-19
Special Issues, Collections and Topics in MDPI journals

Dr. Vasiliki Tsolaki

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Guest Editor

General University Hospital of Larissa, University of Thessaly Faculty of Medicine, 41110 Larissa, Greece
Interests: ARDS; mechanical ventilation; sepsis; hemodynamics; echocardiography; respiratory muscles; diaphragm; esophageal pressure; neuromonitoring; COVID-19
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Journal of Personalized Medicine has launched a Special Issue on “Personalized medicine in the ICU”.

Critical Care Medicine has been dealing with the most vulnerable patient—the critically ill. Pathophysiologic mechanisms of disease and response to disease, monitoring issues and individualized treatment approaches, especially concerning the dosing, are distinct compared to regular patients and vary considerably between critical care patients. Critical Care Departments hospitalize patients with a wide diversity of diseases requiring different management approaches (neurosurgical, thoracic-surgical, general surgical, medical, COVID-19 patients).

More than ever, in the pandemic era, scientists have realized the rationale to personalize medicine, especially for critically ill patients. Clinicians have dealt with patients presenting one disease (COVID-19), but with diversity in clinical, laboratory and pathophysiological findings. This wide variance highlighted the need to identify subpopulations and tailor the treatment applied. Multiple subphenotypes have been identified concerning the presence of ARDS, sepsis, hyperinflammatory syndrome or multiorgan involvement. The pandemic clarified that although there was a huge number of patients suffering from the same disease modality, many randomized controlled trials failed to simplify the therapeutic approach. The underlying different pathophysiologic, cellular and molecular pathways called for individualization of treatments. The “one size does not fit all” approach is translated into precision medicine.

Under this perspective, we are calling for review articles and original contributions covering all aspects of how personalized medicine can improve critically ill patients’ management in the ICU.

Prof. Dr. Epaminondas Zakynthinos
Dr. Vasiliki Tsolaki
Guest Editors

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

ARDS
mechanical ventilation
respiratory mechanics
monitoring
ultrasonography
respiratory muscles
diaphragm
cardiomyopathy
arrhythmias
sepsis
blood stream infections
antimicrobial resistance
ventilator-associated pneumonia
neuromonitoring
MODS
COVID-19

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Published Papers (9 papers)

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Research

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14 pages, 1652 KiB

Open AccessArticle

Effects of Vasopressin Receptor Agonists during the Resuscitation of Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Experimental and Clinical Studies

by Eleni Laou, Nikolaos Papagiannakis, Androniki Papadopoulou, Theodora Choratta, Minas Sakellakis, Mariachiara Ippolito, Ioannis Pantazopoulos, Andrea Cortegiani and Athanasios Chalkias

J. Pers. Med. 2023, 13(7), 1143; https://doi.org/10.3390/jpm13071143 - 16 Jul 2023

Cited by 1 | Viewed by 1808

Abstract

Background: The clinical impact of vasopressin in hemorrhagic shock remains largely unknown. Objective: This systematic review and meta-analysis was designed to investigate the effects of vasopressin receptor agonists during the resuscitation of hemorrhagic shock. Methods: A systematic search of PubMed (MEDLINE), Scopus, and PubMed Central was conducted for relevant articles. Experimental (animal) and clinical studies were included. The primary objective was to investigate the correlation of vasopressin receptor agonist use with mortality and various hemodynamic parameters. Results: Data extraction was possible in thirteen animal studies and two clinical studies. Differences in risk of mortality between patients who received a vasopressin receptor agonist were not statistically significant when compared to those who were not treated with such agents [RR (95% CI): 1.17 (0.67, 2.08); p = 0.562; I² = 50%]. The available data were insufficient to conduct a meta-analysis assessing the effect of vasopressin receptor agonists on hemodynamics. Drawing safe conclusions from animal studies was challenging, due to significant heterogeneity in terms of species and dosage of vasopressin receptor agonists among studies. Conclusions: Differences in risk of mortality between patients who received a vasopressin receptor agonist were not statistically significant when compared to those who were not treated with such agents after hemorrhagic shock. More data are needed to deduce certain conclusions. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

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12 pages, 7512 KiB

Open AccessArticle

Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure

by Evangelia Akoumianaki, Maria Bolaki, Georgios Prinianakis, Ioannis Konstantinou, Meropi Panagiotarakou, Katerina Vaporidi, Dimitrios Georgopoulos and Eumorfia Kondili

J. Pers. Med. 2023, 13(6), 984; https://doi.org/10.3390/jpm13060984 - 12 Jun 2023

Cited by 1 | Viewed by 1978

Abstract

Hiccups-like contractions, including hiccups, respiratory myoclonus, and diaphragmatic tremor, refer to involuntary, spasmodic, and inspiratory muscle contractions. They have been repeatedly described in mechanically ventilated patients, especially those with central nervous damage. Nevertheless, their effects on patient-ventilator interaction are largely unknown, and even more overlooked is their contribution to lung and diaphragm injury. We describe, for the first time, how the management of hiccup-like contractions was individualized based on esophageal and transpulmonary pressure measurements in three mechanically ventilated patients. The necessity or not of intervention was determined by the effects of these contractions on arterial blood gases, patient-ventilator synchrony, and lung stress. In addition, esophageal pressure permitted the titration of ventilator settings in a patient with hypoxemia and atelectasis secondary to hiccups and in whom sedatives failed to eliminate the contractions and muscle relaxants were contraindicated. This report highlights the importance of esophageal pressure monitoring in the clinical decision making of hiccup-like contractions in mechanically ventilated patients. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

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11 pages, 705 KiB

Open AccessArticle

The Real Impact of Age on Mortality in Critically Ill COVID-19 Patients

by Agamemnon Bakakos, Evangelia Koukaki, Sevasti Ampelioti, Iliana Ioannidou, Andriana I. Papaioannou, Konstantinos Loverdos, Antonia Koutsoukou and Nikoleta Rovina

J. Pers. Med. 2023, 13(6), 908; https://doi.org/10.3390/jpm13060908 - 29 May 2023

Cited by 3 | Viewed by 1299

Abstract

Objective: The impact of severe infection from COVID-19 and the resulting need for life support in an ICU environment is a fact that caused immense pressure in healthcare systems around the globe. Accordingly, elderly people faced multiple challenges, especially after admission to the ICU. On this basis, we performed this study to assess the impact of age on COVID-19 mortality in critically ill patients. Materials and Methods: In this retrospective study, we collected data from 300 patients who were hospitalized in the ICU of a Greek respiratory hospital. We split patients into two age groups using a threshold of 65 years old. The primary objective of the study was the survival of patients in a follow up period of 60 days after their admission to the ICU. Secondary objectives were to determine whether mortality is affected by other factors, including sepsis and clinical and laboratory factors, Charlson Comorbidity Index (CCI), APACHE II and d-dimers, CRP, etc. Results: The survival of all patients in the ICU was 75.7%. Those in the <65 years old age group expressed a survival rate of 89.3%, whereas those in the ≥65 years old age group had a survival rate of 58% (p-value < 0.001). In the multivariate Cox regression, the presence of sepsis and an increased CCI were independent predictors of mortality in 60 days (p-value < 0.001), while the age group did not maintain its statistical significance (p-value = 0.320). Conclusions: Age alone as a simple number is not capable of predicting mortality in patients with severe COVID-19 in the ICU. We must use more composite clinical markers that may better reflect the biological age of patients, such as CCI. Moreover, the effective control of infections in the ICU is of utmost importance for the survival of patients, since avoiding septic complications can drastically improve the prognosis of all patients, regardless of age. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

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12 pages, 1726 KiB

Open AccessArticle

Modified SCOPE (mSCOPE) Score as a Tool to Predict Mortality in COVID-19 Critically Ill Patients

by Stavroula Zanelli, Agamemnon Bakakos, Zoi Sotiropoulou, Andriana I. Papaioannou, Evangelia Koukaki, Efstathia Potamianou, Anna Kyriakoudi, Evangelos Kaniaris, Petros Bakakos, Evangelos J. Giamarellos-Bourboulis, Antonia Koutsoukou and Nikoletta Rovina

J. Pers. Med. 2023, 13(4), 628; https://doi.org/10.3390/jpm13040628 - 2 Apr 2023

Viewed by 1576

Abstract

Introduction: Efficient clinical scores predicting the outcome of severe COVID-19 pneumonia may play a pivotal role in patients’ management. The aim of this study was to assess the modified Severe COvid Prediction Estimate score (mSCOPE) index as a predictor of mortality in patients admitted to the ICU due to severe COVID-19 pneumonia. Materials and methods: In this retrospective observational study, 268 critically ill COVID-19 patients were included. Demographic and laboratory characteristics, comorbidities, disease severity, and outcome were retrieved from the electronical medical files. The mSCOPE was also calculated. Results: An amount of 70 (26.1%) of patients died in the ICU. These patients had higher mSCOPE score compared to patients who survived (p < 0.001). mSCOPE correlated to disease severity (p < 0.001) and to the number and severity of comorbidities (p < 0.001). Furthermore, mSCOPE significantly correlated with days on mechanical ventilation (p < 0.001) and days of ICU stay (p = 0.003). mSCOPE was found to be an independent predictor of mortality (HR:1.219, 95% CI: 1.010–1.471, p = 0.039), with a value ≥ 6 predicting poor outcome with a sensitivity (95%CI) 88.6%, specificity 29.7%, a positive predictive value of 31.5%, and a negative predictive value of 87.7%. Conclusion: mSCOPE score could be proved useful in patients’ risk stratification, guiding clinical interventions in patients with severe COVID-19. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

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12 pages, 1739 KiB

Open AccessArticle

Neural Network-Enabled Identification of Weak Inspiratory Efforts during Pressure Support Ventilation Using Ventilator Waveforms

by Stella Soundoulounaki, Emmanouil Sylligardos, Evangelia Akoumianaki, Markos Sigalas, Eumorfia Kondili, Dimitrios Georgopoulos, Panos Trahanias and Katerina Vaporidi

J. Pers. Med. 2023, 13(2), 347; https://doi.org/10.3390/jpm13020347 - 16 Feb 2023

Cited by 3 | Viewed by 1698

Abstract

During pressure support ventilation (PSV), excessive assist results in weak inspiratory efforts and promotes diaphragm atrophy and delayed weaning. The aim of this study was to develop a classifier using a neural network to identify weak inspiratory efforts during PSV, based on the ventilator waveforms. Recordings of flow, airway, esophageal and gastric pressures from critically ill patients were used to create an annotated dataset, using data from 37 patients at 2–5 different levels of support, computing the inspiratory time and effort for every breath. The complete dataset was randomly split, and data from 22 patients (45,650 breaths) were used to develop the model. Using a One-Dimensional Convolutional Neural Network, a predictive model was developed to characterize the inspiratory effort of each breath as weak or not, using a threshold of 50 cmH₂O*s/min. The following results were produced by implementing the model on data from 15 different patients (31,343 breaths). The model predicted weak inspiratory efforts with a sensitivity of 88%, specificity of 72%, positive predictive value of 40%, and negative predictive value of 96%. These results provide a ‘proof-of-concept’ for the ability of such a neural-network based predictive model to facilitate the implementation of personalized assisted ventilation. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

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19 pages, 800 KiB

Open AccessArticle

The Impact of the COVID-19 Pandemic on Mental Health and Quality of Life in COVID-19 Department Healthcare Workers in Central Greece

by Vasileios Aslanidis, Vasiliki Tsolaki, Maria Eirini Papadonta, Theofilos Amanatidis, Kyriaki Parisi, Demosthenes Makris and Epaminondas Zakynthinos

J. Pers. Med. 2023, 13(2), 250; https://doi.org/10.3390/jpm13020250 - 29 Jan 2023

Cited by 8 | Viewed by 2485

Abstract

Background: The pandemic crisis created conditions of insecurity and threat and brought about changes in social contacts and everyday life. Frontline healthcare workers (HCW) were mostly affected. We aimed to evaluate the quality of life and negative emotions in COVID-19 HCW and searched for factors influencing the above. Methods: The present study was conducted among three different academic hospitals in central Greece (04/2020–03/2021). Demographics, attitude towards COVID-19, quality of life, depression, anxiety, stress (using the WHOQOL-BREF and DASS21 questionnaire) and the fear of COVID-19 were assessed. Factors affecting the reported quality of life were also assessed. Results: The study involved 170 HCW in COVID-19 dedicated departments. Moderate levels of quality of life (62.4%), satisfaction with social relations (42.4%), working environment (55.9%) and mental health (59.4%) were reported. Stress was present in 30.6% of HCW; 20.6% reported fear for COVID-19, depression (10.6%) and anxiety (8.2%). HCW in the tertiary hospital were more satisfied with social relations and working environment and had less anxiety. Personal Protective Equipment (PPE) availability affected the quality of life, satisfaction in the work environment and the presence of anxiety and stress. Feeling safe during work influenced social relations and fear of COVID-19 Conclusion: The HCW quality of life is affected in the pandemic. Feelings of safety during work related to the reported quality of life. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

12 pages, 948 KiB

Open AccessArticle

Impact of Early Limitation of Therapeutic Effort in Elderly COVID-19 Patients Admitted to the Intensive Care Unit—A Cohort Study

by Thomas Lacoste-Palasset, Laetitia Sutterlin, Aymen M’Rad, Louis Modestin, Vianney Mourman, Adrien Pepin-Lehalleur, Isabelle Malissin, Giulia Naim, Caroline Grant, Emmanuelle Guérin, Jean-Michel Ekhérian, Nicolas Deye, Bruno Mégarbane and Sebastian Voicu

J. Pers. Med. 2022, 12(9), 1501; https://doi.org/10.3390/jpm12091501 - 14 Sep 2022

Cited by 2 | Viewed by 1812

Abstract

(1) Background: Admission to the ICU and intensity of care provided to elderly COVID-19 patients are difficult choices guided by the expected patient-centered benefits. However, the impact of an early discussion of limitation of therapeutic effort (LTE) has been poorly investigated. (2) Methods: We performed a single-center retrospective cohort study including all ≥70-year-old COVID-19 patients admitted to the ICU. Factors associated with early LTE discussion (defined as before or up to 2 days post-ICU admission) and in-hospital mortality were evaluated. (3) Results: Eighty-two patients (59 M/23 F; 78 years (74–82) [median (interquartile range)]; 43/82 with LTE) were included. The in-hospital mortality rate was 55%. Early LTE was decided upon for 22/82 patients (27%), more frequently in older (p < 0.001) and frailer patients (p = 0.004). Using a multivariable logistic regression model including clinical frailty scale grade ≥4, hospital acquisition of COVID-19, ventilation support modality and SOFA score on admission, early LTE was not associated with mortality (adjusted odds ratio = 0.57 (0.15–2.00), p = 0.39). LTE resulted in less frequent invasive mechanical ventilation (23% versus 65%, p = 0.001), renal replacement therapy (5% versus 27%, p = 0.03) and norepinephrine infusion (23% versus 60%, p = 0.005), and shorter ICU stay (6 days (2–12) versus 14 days (7–24), p = 0.001). (4) Conclusions: In this small sample exploratory study, we were unable to demonstrate any increase in in-hospital mortality associated with early LTE discussion in elderly COVID-19 patients while reducing the use of organ support techniques. These findings require confirmation in larger studies. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

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Review

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14 pages, 320 KiB

Open AccessReview

Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients

by Vasiliki Tsolaki, George E. Zakynthinos, Maria-Eirini Papadonta, Fotini Bardaka, George Fotakopoulos, Ioannis Pantazopoulos, Demosthenes Makris and Epaminondas Zakynthinos

J. Pers. Med. 2022, 12(9), 1538; https://doi.org/10.3390/jpm12091538 - 19 Sep 2022

Cited by 11 | Viewed by 2714

Abstract

Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified. The rationale is to minimize the risk for lung damage progression, in the already-injured pulmonary parenchyma. By abolishing rigorous spontaneous efforts, NMBAs may decrease the generation of high transpulmonary pressures that could aggravate patients’ self-inflicted lung injury. Moreover, NMBAs can harmonize the patient–ventilator interaction. Recent randomized controlled trials reported contradictory results and changed the clinical practice in a bidirectional way. NMBAs have not been documented to improve long-term survival; thus, the current guidance suggests their use only in patients in whom a lung protective ventilation protocol cannot be applied, due to asynchrony or increased respiratory efforts. In the present review, we discuss the published data and additionally the clinical practice in the “war” conditions of the COVID-19 pandemic, concerning NMBA use in the management of patients with ARDS. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

Other

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10 pages, 577 KiB

Open AccessViewpoint

Rethinking Fluid Responsiveness during Septic Shock: Ameliorate Accuracy of Noninvasive Cardiac Output Measurements through Evaluation of Arterial Biomechanical Properties

by Vasileios Papaioannou and Theodoros Papaioannou

J. Pers. Med. 2024, 14(1), 70; https://doi.org/10.3390/jpm14010070 - 5 Jan 2024

Cited by 1 | Viewed by 1859

Abstract

Beat-to-beat estimates of cardiac output from the direct measure of peripheral arterial blood pressure rely on the assumption that changes in the waveform morphology are related to changes in blood flow and vasomotor tone. However, in septic shock patients, profound changes in vascular tone occur that are not uniform across the entire arterial bed. In such cases, cardiac output estimates might be inaccurate, leading to unreliable evaluation of fluid responsiveness. Pulse wave velocity is the gold-standard method for assessing different arterial biomechanical properties. Such methods might be able to guide, personalize and optimize the management of septic patients. Full article

(This article belongs to the Special Issue Personalized Medicine in the ICU)

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