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Medicina
Special Issues
Conundrums in Critical Care: Past, Present and Future
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Conundrums in Critical Care: Past, Present and Future

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

Deadline for manuscript submissions: closed (31 October 2023) | Viewed by 1926

Special Issue Editors

Dr. Salim Surani

E-Mail Website
Guest Editor
Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Texas A&M University, College Station, TX, USA
Interests: critical care; quality improvement; pulmonary hypertension; IPF; sleep medicine; sepsis
Special Issues, Collections and Topics in MDPI journals
Dr. Syed Anjum Khan

E-Mail Website
Guest Editor
Mayo Clinic Health System, Mankato, MN, USA
Interests: critical care; quality improvement; leadership; sepsis; respiratory failure
Dr. Iqbal Ratnani

E-Mail Website
Guest Editor
Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA
Interests: critical care; education; PI; ECMO; sepsis; cardiovascular critical care

Special Issue Information

Dear Colleagues, 

Critical care has evolved exponentially in the last 60 years. In 1850, during the Crimean War, nurses created an area near their station for critically injured soldiers. This may well have been the beginning of critical care.

During World War II, shock units were created to treat critically ill patients.

The greatest discovery in critical care may have been the iron lung during the polio epidemic, followed by the development of mechanical ventilators in the 1960s.

Monitoring techniques were developed, and nurses, respiratory therapists, and physicians were trained specifically in the management of multiorgan failures, leading to evolution of intensive care units.

The inception of intensive care units was the harbinger of coordinated and protocolized care models. These protocols have mostly been successful; however, some controversies have existed.

Fluid resuscitation, treatment with steroids, glycemic control, and early mobility have transcended over the years and have later been questioned by their restrictive aspects.

In this Special Issue, we will discuss this controversy and focus on what the future brings for critical care practices.

Dr. Salim Surani
Dr. Syed Anjum Khan
Dr. Iqbal Ratnani
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. 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

  • critical care
  • ICU
  • ICU future
  • ICU history
  • education
  • sepsis
  • mechanical ventilator
  • fluid balance
  • glycemic control
  • staff shortage
  • ICU matrix
  • antibiotic stewardship
  • controversies in medicine
  • burnout

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Published Papers (1 paper)

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9 pages, 1506 KiB  
Case Report
Comparing Long-Term Prognosis in Chronic Critically Ill Patients: A Case Series Study of Medical versus Surgical Sepsis
by Benjamin Mancini, Jiabin Liu, Abigail Samuelsen, Judie A. Howrylak, Lisa Schultz and Anthony S. Bonavia
Medicina 2023, 59(9), 1617; https://doi.org/10.3390/medicina59091617 - 7 Sep 2023
Cited by 2 | Viewed by 1587
Abstract
Background and Objectives: Chronic critical illness (CCI) is a syndrome characterized by persistent organ dysfunction that requires critical care therapy for ≥14 days. Sepsis and respiratory failure constitute the two primary causes of CCI. A better understanding of this patient population and their [...] Read more.
Background and Objectives: Chronic critical illness (CCI) is a syndrome characterized by persistent organ dysfunction that requires critical care therapy for ≥14 days. Sepsis and respiratory failure constitute the two primary causes of CCI. A better understanding of this patient population and their clinical course may help to risk-stratify them early during hospitalization. Our objective was to identify whether the source of sepsis (medical versus surgical) affected clinical trajectory and prognosis in patients developing CCI. Materials and Methods: We describe a cohort of patients having acute respiratory failure and sepsis and requiring critical care therapy in the medical (MICU) or surgical (SICU) critical care units for ≥14 days. Given the relative infrequency of CCI, we use a case series design to examine mortality, functional status, and place of residence (home versus non-home) at one year following their index hospitalization. Results: In medical patients developing CCI (n = 31), the severity of initial organ dysfunction, by SOFA score, was significantly associated with the development of CCI (p = 0.002). Surgical patients with CCI (n = 7) experienced significantly more ventilator-free days within the first 30 days following sepsis onset (p = 0.004), as well as less organ dysfunction at day 14 post-sepsis (p < 0.0001). However, one-year mortality, one-year functional status, and residency at home were not statistically different between cohorts. Moreover, 57% of surgical patients and 26% of medical patients who developed CCI were living at home for one year following their index hospitalization (p = 0.11). Conclusions: While surgical patients who develop sepsis-related CCI experience more favorable 30-day outcomes as compared with medical patients, long-term outcomes do not differ significantly between groups. This suggests that reversing established organ dysfunction and functional disability, regardless of etiology, is more challenging compared to preventing these complications at an earlier stage. Full article
(This article belongs to the Special Issue Conundrums in Critical Care: Past, Present and Future)
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