Critical Care Update: Challenges of the Third Millennium

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

Deadline for manuscript submissions: closed (20 May 2023) | Viewed by 12233

Special Issue Editor

Special Issue Information

Dear Colleagues,

The outstanding developments in anesthesia and critical care in recent decades have led to improved patient outcomes and reduced mortality. Further advances in this more than 70-year-old care concept are warranted. The multidisciplinary care of critically ill patients is an integral part of every modern healthcare system, ensuring improved outcomes and reduced mortality, which are guaranteed via the prompt development of diverse diagnostic as well as therapeutic modalities and supported by the continuous education of health workers. Faster and easier access to care, the early recognition of severe illnesses, advanced prehospital care, and organized emergency care all contribute to treatment strategies for critically ill patients. Furthermore, the quick development of technologies in addition to continuous research in the fields of anesthesia and critical care face a need for the wide dissemination of information to clinicians.

This Special Issue on “Critical Care Update: Challenges of the Third Millennium” welcomes the submission of work related to the most recent developments in and challenges of the third millennium related to the advances in experimental and clinical anesthesia, intensive care, and emergency medicine research as well as practice, addressing innovative therapeutic and diagnostic strategies in the care of the critically ill. Moreover, with this Special Issue we would like to additionally support works related to transplantation medicine, infections in critical care, and artificial intelligence. We invite all researchers from associated disciplines who focus on the care of acutely ill patients to submit original articles or reviews in their areas of expertise, enhancing the multidisciplinarity of modern critical care.

Dr. Sasa Rajsic
Guest Editor

Manuscript Submission Information

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Published Papers (5 papers)

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Research

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15 pages, 2360 KiB  
Article
Developing an Interpretable Machine Learning Model to Predict in-Hospital Mortality in Sepsis Patients: A Retrospective Temporal Validation Study
by Shuhe Li, Ruoxu Dou, Xiaodong Song, Ka Yin Lui, Jinghong Xu, Zilu Guo, Xiaoguang Hu, Xiangdong Guan and Changjie Cai
J. Clin. Med. 2023, 12(3), 915; https://doi.org/10.3390/jcm12030915 - 24 Jan 2023
Cited by 3 | Viewed by 1520
Abstract
Background: Risk stratification plays an essential role in the decision making for sepsis management, as existing approaches can hardly satisfy the need to assess this heterogeneous population. We aimed to develop and validate a machine learning model to predict in-hospital mortality in critically [...] Read more.
Background: Risk stratification plays an essential role in the decision making for sepsis management, as existing approaches can hardly satisfy the need to assess this heterogeneous population. We aimed to develop and validate a machine learning model to predict in-hospital mortality in critically ill patients with sepsis. Methods: Adult patients fulfilling the definition of Sepsis-3 were included at a large tertiary medical center. Relevant clinical features were extracted within the first 24 h in ICU, re-classified into different genres, and utilized for model development under three strategies: “Basic + Lab”, “Basic + Intervention”, and “Whole” feature sets. Extreme gradient boosting (XGBoost) was compared with logistic regression (LR) and established severity scores. Temporal validation was conducted using admissions from 2017 to 2019. Results: The final cohort included 24,272 patients, of which 4013 patients formed the test cohort for temporal validation. The trained and fine-tuned XGBoost model with the whole feature set showed the best discriminatory ability in the test cohort with AUROC as 0.85, significantly higher than the XGBoost “Basic + Lab” model (0.83), the LR “Whole” model (0.82), SOFA (0.63), SAPS-II (0.73), and LODS score (0.74). The performance in varying subgroups remained robust, and predictors, such as increased urine output and supplemental oxygen therapy, were crucially correlated with improved survival when interpretability was explored. Conclusions: We developed and validated a novel XGBoost-based model and demonstrated significantly improved performance to LR and other scores in predicting the mortality risks of sepsis patients in the hospital using features in the first 24 h. Full article
(This article belongs to the Special Issue Critical Care Update: Challenges of the Third Millennium)
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9 pages, 1135 KiB  
Article
Evaluation of the New SingularityTM Air versus Ambu® Aura GainTM: A Randomized, Crossover Mannequin Study
by Lukas Gasteiger, Rouven Hornung, Simon Woyke, Elisabeth Hoerner, Sabrina Neururer and Berthold Moser
J. Clin. Med. 2022, 11(24), 7266; https://doi.org/10.3390/jcm11247266 - 7 Dec 2022
Cited by 1 | Viewed by 972
Abstract
Background: This randomised crossover mannequin study aimed to compare the insertion time for the newly developed SingularityTM Air and the Ambu® AuraGainTM. The SingularityTM Air includes a bendable tube in order to allow optimal passform. Methods: Fifty anaesthetists [...] Read more.
Background: This randomised crossover mannequin study aimed to compare the insertion time for the newly developed SingularityTM Air and the Ambu® AuraGainTM. The SingularityTM Air includes a bendable tube in order to allow optimal passform. Methods: Fifty anaesthetists with a minimum of 100 supraglottic airway device insertions were recruited and randomly assigned to start either with the SingularityTM Air or with the Ambu® AuraGainTM. Participants watched a tutorial video the day before the assessment and received a standardized introduction immediately before the assessment. The primary outcome was the time for successful insertion. Secondary parameters were the overall insertion success rate, the numbers of insertion attempts (maximum three), the glottic view through a flexible bronchoscope, and the success rate for gastric tube insertion. Results: Fifty participants were eventually recruited and randomly assigned to insert both devices according to the randomization. The insertion time was 24 s for SingularityTM Air as compared to 20 s for Ambu® AuraGainTM (p < 0.001). Overall insertion rate was 92% for the SingularityTM Air as compared to 100% for the Ambu® AuraGainTM (p could not be derived as one variable is a constant). The primary insertion success rate was better for the Ambu® AuraGainTM than for the SingularityTM Air (94% versus 68%; p: 0.002, respectively). Conclusion: The time for successful insertion and the insertion success rate for the newly developed SingularityTM Air is inferior to that for the Ambu® AuraGainTM. Full article
(This article belongs to the Special Issue Critical Care Update: Challenges of the Third Millennium)
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11 pages, 445 KiB  
Article
ECMO Support in Refractory Cardiogenic Shock: Risk Factors for Mortality
by Sasa Rajsic, Robert Breitkopf, Zoran Bukumiric and Benedikt Treml
J. Clin. Med. 2022, 11(22), 6821; https://doi.org/10.3390/jcm11226821 - 18 Nov 2022
Cited by 2 | Viewed by 1477
Abstract
Background: Veno-arterial extracorporeal membrane oxygenation (va-ECMO) is a specialized temporary support for patients with refractory cardiogenic shock. The true value of this potentially lifesaving modality is still a subject of debate. Therefore, we aimed to investigate the overall in-hospital mortality and identify potential [...] Read more.
Background: Veno-arterial extracorporeal membrane oxygenation (va-ECMO) is a specialized temporary support for patients with refractory cardiogenic shock. The true value of this potentially lifesaving modality is still a subject of debate. Therefore, we aimed to investigate the overall in-hospital mortality and identify potential risk factors for mortality. Methods: We retrospectively analyzed the data of 453 patients supported with va-ECMO over a period of 14 years who were admitted to intensive care units of a tertiary university center in Austria. Results: We observed in-hospital mortality of 40% for patients with refractory cardiogenic shock. Hemorrhage, ECMO initiation on weekends, higher SAPS III score, and sepsis were identified as significant risk factors for mortality. Hemorrhage was the most common adverse event (46%), with major bleeding events dominating in deceased patients. Thromboembolic events occurred in 25% of patients, followed by sepsis (18%). Conclusions: Although the rates of complications are substantial, a well-selected proportion of patients with refractory cardiogenic shock can be rescued from probable death. The reported risk factors could be used to increase the awareness of clinicians towards the development of new therapeutic concepts that may reduce their incidence. Full article
(This article belongs to the Special Issue Critical Care Update: Challenges of the Third Millennium)
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Review

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19 pages, 1106 KiB  
Review
Extracorporeal Membrane Oxygenation (VA-ECMO) in Management of Cardiogenic Shock
by Klaudia J. Koziol, Ameesh Isath, Shiavax Rao, Vasiliki Gregory, Suguru Ohira, Sean Van Diepen, Roberto Lorusso and Chayakrit Krittanawong
J. Clin. Med. 2023, 12(17), 5576; https://doi.org/10.3390/jcm12175576 - 26 Aug 2023
Cited by 2 | Viewed by 4140
Abstract
Cardiogenic shock is a critical condition of low cardiac output resulting in insufficient systemic perfusion and end-organ dysfunction. Though significant advances have been achieved in reperfusion therapy and mechanical circulatory support, cardiogenic shock continues to be a life-threatening condition associated with a high [...] Read more.
Cardiogenic shock is a critical condition of low cardiac output resulting in insufficient systemic perfusion and end-organ dysfunction. Though significant advances have been achieved in reperfusion therapy and mechanical circulatory support, cardiogenic shock continues to be a life-threatening condition associated with a high rate of complications and excessively high patient mortality, reported to be between 35% and 50%. Extracorporeal membrane oxygenation can provide full cardiopulmonary support, has been increasingly used in the last two decades, and can be used to restore systemic end-organ hypoperfusion. However, a paucity of randomized controlled trials in combination with high complication and mortality rates suggest the need for more research to better define its efficacy, safety, and optimal patient selection. In this review, we provide an updated review on VA-ECMO, with an emphasis on its application in cardiogenic shock, including indications and contraindications, expected hemodynamic and echocardiographic findings, recommendations for weaning, complications, and outcomes. Furthermore, specific emphasis will be devoted to the two published randomized controlled trials recently presented in this setting. Full article
(This article belongs to the Special Issue Critical Care Update: Challenges of the Third Millennium)
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13 pages, 1029 KiB  
Review
Design and Implementation of Airway Response Teams to Improve the Practice of Emergency Airway Management
by Kelly A. Tankard, Milad Sharifpour, Marvin G. Chang and Edward A. Bittner
J. Clin. Med. 2022, 11(21), 6336; https://doi.org/10.3390/jcm11216336 - 27 Oct 2022
Cited by 8 | Viewed by 3510
Abstract
Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, the practice of EAM [...] Read more.
Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, the practice of EAM is associated with significant morbidity and mortality. Evidence suggests that a dedicated airway response team (ART) can help mitigate the risks associated with EAM and provide a framework for airway management in acute settings. We review the risks and challenges related to EAM and describe strategies to improve patient care and outcomes via implementation of an ART. Full article
(This article belongs to the Special Issue Critical Care Update: Challenges of the Third Millennium)
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