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Lung Injury and the Intensive Care Unit: Pathophysiology, Clinical Practice...
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Lung Injury and the Intensive Care Unit: Pathophysiology, Clinical Practice and Treatment for Better Outcomes

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

Deadline for manuscript submissions: closed (1 February 2024) | Viewed by 3869

Special Issue Editors

Dr. Emanuele Rezoagli

E-Mail Website
Guest Editor
1. School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
2. Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
Interests: mechanical ventilation; non-invasive ventilation; ARDS; respiratory mechanics; hemodynamics; respiratory pathophysiology; lung monitoring; lung imaging; nitric oxide; extracorporeal membrane oxygenation
Special Issues, Collections and Topics in MDPI journals
Dr. Matteo Pozzi

E-Mail Website
Guest Editor
1. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
2. Department of Emergency and Intensive Care, Terapia Intensiva e Semintensiva Adulti e Pediatrica, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
Interests: mechanical ventilation; non-invasive ventilation; ARDS; extracorporeal membrane oxygenation; long-term outcome
Special Issues, Collections and Topics in MDPI journals
Dr. Luca Bastia

E-Mail Website
Guest Editor Assistant
Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
Interests: respiratory mechanics; ARDS; lung monitoring; mechanical ventilation

Special Issue Information

Dear Colleagues,

Mortality in patients with respiratory failure in the presence of lung injury is still unacceptably high.

The pathophysiology of lung injury is complex, and over recent decades great efforts have been undertaken to better understand the mechanisms behind the disease by using advanced lung monitoring and lung imaging diagnostic techniques. These include:

  1. The analysis of the regional distribution of ventilation and of the lung resting volume;
  2. Esophageal pressure monitoring to assess the partitioned respiratory mechanics;
  3. Diagnostic tools to capture patient drive and effort during assisted mechanical ventilation and non-invasive respiratory support.

This technology aims at supporting clinical practice—which is the everyday system of patient care—to achieve better treatments and consequently better outcomes.

In this Special Issue, we welcome scientific contributions regarding respiratory failure in critically ill patients that aim to:

  1. Better understand the disease by exploring different lung imaging and monitoring techniques in patients undergoing invasive or non-invasive ventilation;
  2. Investigate clinical practice in the presence of large databases on respiratory failure; and
  3. Explore long-term functional and patient-oriented outcomes, their possible predictors and the effectiveness of specific post-discharge interventions in the context of longitudinal follow-up programs.

Dr. Emanuele Rezoagli
Dr. Matteo Pozzi
Guest Editors
Dr. Luca Bastia
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 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

  • respiratory failure
  • lung injury
  • mechanical ventilation
  • non-invasive ventilation
  • follow-up
  • mortality
  • pathophysiology
  • diagnostics
  • imaging

Published Papers (3 papers)

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Research

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10 pages, 705 KiB  
Article
Safety and Effectiveness of Intensive Treatments Administered Outside the Intensive Care Unit to Hematological Critically Ill Patients: An Intensive Care without Walls Trial
by Beatrice Vergnano, Davide Signori, Annalisa Benini, Serena Calcinati, Francesca Bettini, Luisa Verga, Lorenza Maria Borin, Fabrizio Cavalca, Carlo Gambacorti-Passerini, Giacomo Bellani and Giuseppe Foti
J. Clin. Med. 2023, 12(19), 6281; https://doi.org/10.3390/jcm12196281 - 29 Sep 2023
Cited by 1 | Viewed by 524
Abstract
Historically, the admission of hematological patients in the ICU shortly after the start of a critical illness is associated with better survival rates. Early intensive interventions administered by MET could play a role in the management of hematological critically ill patients, eventually reducing [...] Read more.
Historically, the admission of hematological patients in the ICU shortly after the start of a critical illness is associated with better survival rates. Early intensive interventions administered by MET could play a role in the management of hematological critically ill patients, eventually reducing the ICU admission rate. In this retrospective and monocentric study, we evaluate the safety and effectiveness of intensive treatments administered by the MET in a medical ward frame. The administered interventions were mainly helmet CPAP and pharmacological cardiovascular support. Frequent reassessment by the MET at least every 8 to 12 h was guaranteed. We analyzed data from 133 hematological patients who required MET intervention. In-hospital mortality was 38%; mortality does not increase in patients not immediately transferred to the ICU. Only three patients died without a former admission to the ICU; in these cases, mortality was not related to the acute illness. Moreover, 37% of patients overcame the critical episode in the hematological ward. Higher SOFA and MEWS scores were associated with a worse survival rate, while neutropenia and pharmacological immunosuppression were not. The MET approach seems to be safe and effective. SOFA and MEWS were confirmed to be effective tools for prognostication. Full article
(This article belongs to the Special Issue Lung Injury and the Intensive Care Unit: Pathophysiology, Clinical Practice and Treatment for Better Outcomes)
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15 pages, 556 KiB  
Article
Hospital Memories and Six-Month Psychological Outcome: A Prospective Study in Critical Ill Patients with COVID-19 Respiratory Failure
by Matteo Pozzi, Claudio Ripa, Valeria Meroni, Daniela Ferlicca, Alice Annoni, Marta Villa, Maria Grazia Strepparava, Emanuele Rezoagli, Simone Piva, Alberto Lucchini, Giacomo Bellani, Giuseppe Foti and the Monza Follow-Up Study Group
J. Clin. Med. 2023, 12(9), 3344; https://doi.org/10.3390/jcm12093344 - 08 May 2023
Cited by 2 | Viewed by 1256
Abstract
ICU survivors suffer from various long-term physical and psychological impairments. Memories from the critical illness may influence long-term psychological outcome. In particular, the role of ICU memories in COVID-19 critically ill patients is unknown. In a prospective observational study, we aimed to investigate [...] Read more.
ICU survivors suffer from various long-term physical and psychological impairments. Memories from the critical illness may influence long-term psychological outcome. In particular, the role of ICU memories in COVID-19 critically ill patients is unknown. In a prospective observational study, we aimed to investigate patients’ memories from the experience of critical illness and their association with a six-month psychological outcome involving quality of life evaluation. Patients’ memories were investigated with ICU Memory tool, while psychological outcome and quality of life were evaluated by means of a battery of validated questionnaires during an in-person interview at the follow-up clinic. 149 adult patients were enrolled. 60% retained memories from pre-ICU days spent on a general ward, while 70% reported memories from the in-ICU period. Delusional memories (i.e., memories of facts that never happened) were reported by 69% of patients. According to a multivariable analysis, the lack of pre-ICU memories was an independent predictor of worse psychological outcomes in terms of anxiety, depression and Post-traumatic Stress Disorder (PTDS). Factors associated with long-term outcome in ICU survivors are not still fully understood and patients’ experience during the day spent before ICU admission may be associated with psychological sequelae. Full article
(This article belongs to the Special Issue Lung Injury and the Intensive Care Unit: Pathophysiology, Clinical Practice and Treatment for Better Outcomes)
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Review

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18 pages, 291 KiB  
Review
Using Artificial Intelligence to Predict Mechanical Ventilation Weaning Success in Patients with Respiratory Failure, Including Those with Acute Respiratory Distress Syndrome
by Tamar Stivi, Dan Padawer, Noor Dirini, Akiva Nachshon, Baruch M. Batzofin and Stephane Ledot
J. Clin. Med. 2024, 13(5), 1505; https://doi.org/10.3390/jcm13051505 - 05 Mar 2024
Viewed by 1706
Abstract
The management of mechanical ventilation (MV) remains a challenge in intensive care units (ICUs). The digitalization of healthcare and the implementation of artificial intelligence (AI) and machine learning (ML) has significantly influenced medical decision-making capabilities, potentially enhancing patient outcomes. Acute respiratory distress syndrome, [...] Read more.
The management of mechanical ventilation (MV) remains a challenge in intensive care units (ICUs). The digitalization of healthcare and the implementation of artificial intelligence (AI) and machine learning (ML) has significantly influenced medical decision-making capabilities, potentially enhancing patient outcomes. Acute respiratory distress syndrome, an overwhelming inflammatory lung disease, is common in ICUs. Most patients require MV. Prolonged MV is associated with an increased length of stay, morbidity, and mortality. Shortening the MV duration has both clinical and economic benefits and emphasizes the need for better MV weaning management. AI and ML models can assist the physician in weaning patients from MV by providing predictive tools based on big data. Many ML models have been developed in recent years, dealing with this unmet need. Such models provide an important prediction regarding the success of the individual patient’s MV weaning. Some AI models have shown a notable impact on clinical outcomes. However, there are challenges in integrating AI models into clinical practice due to the unfamiliar nature of AI for many physicians and the complexity of some AI models. Our review explores the evolution of weaning methods up to and including AI and ML as weaning aids. Full article
(This article belongs to the Special Issue Lung Injury and the Intensive Care Unit: Pathophysiology, Clinical Practice and Treatment for Better Outcomes)
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